Archive for December 2019

Factors That Can Hinder Carpal Tunnel Syndrome Recovery

As with most musculoskeletal conditions, treatment plans for carpal tunnel syndrome (CTS) advise non-surgical or conservative management initially, with surgery only in emergency situations or after non-surgical options are exhausted. Can we know who will benefit the most from non-surgical treatment?

A study conducted a two-stage analysis which included an initial evaluation followed by non-surgical treatment and a re-evaluation one year after non-surgical treatment concluded. The main aim of the study was to analyse factors contributing to the long-term effects of non-surgical treatment of CTS and to identify failure risk factors. Read more here.

The study involved patients diagnosed with CTS, of which an occupational cause was identified in (76%). Treatment included a total of ten sessions of whirlpool massage to the wrist and hand, ultrasound, and median nerve glide exercises performed at home. The subjects were divided into three age groups: <50, 51-59, ≥60 years old.

Whilst the majority of patients felt substantial progress in both stages of the study, some did not. Patients with more acute cases, as evidenced by poor results on a nerve conduction velocity (NCV) test, were less likely to respond to care, which highlights the importance of seeking early treatment for CTS as soon as symptoms develop.

Furthermore, participants who did not improve the setup of their working environments and reduce the overuse of their hands at work or who did not modify their routines to reduce the stress applied on the hands and wrist, reported much lower levels of improvements at the one-year point. Interestingly, age was not found to be a significant factor, which is surprising, as past studies have reported that being over 50 year of age is a risk factor.

Not only are Osteopaths trained in the same non-surgical treatment methods used in this study, but they can combine such approaches with nutritional counselling (to reduce inflammation) and manual therapies to improve function in the wrist and other sites along the course of the median nerve to achieve the best possible results for their patients.

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back pain

Jobs that cause Back Pain and what can be done

Back problems are now routine in society. This makes it very important to understand what may be causing this and what factors within your lifestyle could be changed to aid or prevent this issue from arising at all. Whilst we can’t change our DNA and current make up, nor in some instances our jobs, how we interact in our daily tasks and movements can be the difference between minor aches and disabling pain.

Construction industry roles typically are very strenuous on the back for example, Concrete-reinforcement workers and carpenters have more back pain than what is typically seen in office workers.

However, carpal tunnel syndrome can be much more prevalent in office workers. Different roles put different pressures and strains on different areas of the body.

Heavy lifting in awkward positions can put the back discs under load which exceeds the strength of the ligaments. This is called a sprain and in a severe case the disc can bulge and herniate.

If the worker can lift in less awkward positions with good ergonomics, then the discs are less likely to herniate as they are under less load. It’s common that the spine is stiff in the morning and develops higher levels of pressure in the discs, so it is not recommended that the worker does as much heavy lifting at this time.

Being mindful of this it’s much safer to lift lighter loads in the morning. Nevertheless, at any stage of the day lifting and twisting makes the spine far more susceptible to injury. Getting help is the main prevention many people do not consider.

Sitting for lengthy periods of time can be damaging to the spine. Initially because there is the inactivity which causes muscles to weaken. The spine is designed for movement walking. As the saying goes, “an apple a day” is good but a walk a day is better.

The spine is built to move, especially walk. Sitting causes heightened pressure in the discs of the low back. If you add vibration (e.g. bus/taxi driver) the sitting effects are worse. Regular walks and a proper supporting seat help to minimise any future back issues.

Every individual work situation has its own stresses and strain on the body and each and should be assessed appropriately. The correct spinal posture while working is key to overall good health and is the best prevention for back injury.

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knee pain

Causes of Knee Pain

When we experience knee pain, is it the knee the issue is stemming from?

Several studies have been written stating a link with knee pain to problems with the lower back, hips, ankles, and feet. Because we walk on two legs, everything from the ground up affects the rest of the body. The first “link” in this “kinetic chain” is our feet, and the last link is the head.

If any of the lower links are affected this has a ripple effect up through the rest of the body and in most instances, having a negative effect. For example, a “knocked knee” can be a cause of a flat foot or pronated ankle whereby the foot rolls in the way. If you look around you when you are in town or in the supermarket you will see how people walk on their insteps.

You will see this in particular on holiday amongst those wearing shorts and flip flops. It is estimated that the vast majority of us are over-pronating by the age of 30. Many of us are born with flat feet and as a result can be suffering from this from the minute we start to walk.

There are several tissues in the knee that can produce pain. In the over-pronation situation, the knee is overloaded so the medial, or inside compartment, of the knee is opening up excessively whilst the lateral, or outer compartment, over-compresses or jams together. We often find medial and/or lateral compartment pain in the over-pronated ankle/knocked-knee side.

The front section of the knee houses the kneecap that slides in a groove, and the knocked-knee results in overloading on the outside of the knee cap/groove creating a condition called lateral patellofemoral pressure syndrome and/or chondromalacia patella.

When you present for an Osteopathic evaluation, your Osteopath will pay attention to your gait or walking rhythm and look for over-pronation. You can correct the pronation effect with an orthotic foot wedge, which would hopefully prevent any conditions from arising in the future, such as arthritis.

Exercise is key as it is so important to keep the muscles around the knee stretched and strong. There is one muscle in particular, the vastus medialis oblique or VMO that connects our upper/inner kneecap to the medial/inside leg. It is the muscle that counteracts the outward pull by the other quadriceps muscles that attach to the kneecap. Your Osteopath can show you how to specifically exercise and isolate the VMO, if necessary. Book online now at

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shoulder pain

What Causes Shoulder Pain?

Every year, thousands of people make doctor visits related to shoulder/upper arm pain. After neck and back pain, shoulder pain is one of the top reason’s patients seek Osteopathic care. So, why are shoulder injuries so widespread?

There are many feasible reasons that address this query, there’s a simple answer:

Anatomy. There are essentially three joints that make up the shoulder:

1) scapulothoracic joint

2) the glenohumeral joint

3) the acromioclavicular joint

These joints work concurrently and in coherence to complete many tasks we throw at our upper extremities from swinging a golf club to lifting weights, to reaching up to hang new wallpaper. The overall structure of the shoulder favours flexibility over stability and as a result, there is a larger possibility for injury. What can we do to prevent shoulder injuries?

Perhaps the most essential approach is to think before you act; that is, don’t take pointless chances like over-lifting in particularly problematic positions, ask someone else for help instead. Keep yourself in good condition, interestingly keeping a strong core is linked to healthy shoulder joints.

Most common shoulder ailments include (but are not limited to): inflammation (bursitis and tendinitis), instability (“sloppy” joints), arthritis (bone/cartilage injury/wear), fracture, and nerve injuries. Injuries can be acute (from an obvious cause) or more commonly, they can be chronic from wear and tear and can occur progressively over time (from no obvious, single cause).

It’s essential to appreciate that a shoulder disorder may be the end result of dysfunction throughout the body, just as a knee problem can place added stress on the hip (or vice versa). So, with a view to creating a successful treatment plan, your Osteopath may identify and treat conditions somewhere else within the body, that likely contribute to your shoulder pain disorder. Your Osteopath may also recommend certain food or vitamins/supplements with the aim of reducing inflammation, order to promote a faster recovery.

If you are suffering for shoulder pain you can book online at

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hip pain, back back

Do You Have a Hip Problem, Back Problem, or Both?

Back and Hip pain are amongst some of the most common Musculoskeletal ailments, forcing thousands of patients to Osteopaths each week. Because the hip and low back are closely linked within the body structure, many of these conditions often intersect, with only one of the two issues being diagnosed. This can cause wrong or missed diagnosis, leading to ineffective treatment, avoidable costs, and unsatisfying outcomes for the patient with prolonged pain, disability, and mental health distress.

In some instances, a problem somewhere else in the anatomy can send pain in another areas. For example, upper neck dysfunction could result in symptoms in the hand and wrist that could be perceived as carpal tunnel syndrome. Or for example, a problem with a patient’s foot arch, can alter a person’s gait and lead to a problem with the knee. Which can lead to wrong diagnosis and a treatment plan for the knee is undertaken instead of the foot and knee. With the hip and low back, both scenarios can occur, which is why it’s important to focus on the whole patient and not just the area of main concern or discomfort.

This is why Osteopaths consider the whole patient when they qualify patients’ conditions like hip pain or back pain, starting with a thorough patient history. Areas like Pain Location, Medical History (or Mechanism of injury), New, Other Symptoms (or, Onset), Provoking/Palliative, Quality, Radiation, Severity, and Timing.

The remaining history of Past, Family, and Social histories and, a Review of Systems allows the Osteopath to consider other potentially important aspects of the patient’s past such as prior injuries, accidents, surgeries, current medications, genetics, social aspects (smoking, drinking, exercise habits, sleep quality) and more, which can give clues to the current issues. These tactics serve as good outcome tools to determine successful treatment programs and patient care.

The examination includes observing the patients posture, walk and move and their affect (is their condition all-consuming); palpating or feeling for painful structures and performing movements that both increase and relieve their pain; measuring patient’s range of motion; determining what position is favoured or “best” vs. “worst”; and nerve function tests to look for impairments with regards to sensation, strength, and reflexes.

Each part of the Osteopaths examination and qualification process is designed to arrive at the correct diagnosis, so that treatment can accurately target healing and improving the function of ailing parts.

If you have a have a hip problem, back problem, or both, book online

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Neck Pain

Exercise and Posture Training for Neck Pain

Poor posture is extremely common. This may be why thousands of people are Googling an “Osteopath near me” on a regular basis.

If you look around any airport, museum, auditorium or social event, most people are suffering from poor posture. There’s forward head posture, uneven/misaligned heads/shoulders/pelvis-hips and rolled forward shoulders all around us. Many patients shuffle or limp whilst walking as a result of this.

Added strain on various parts of a patient’s anatomy happens as a result of bad or abnormal posture. A result of this can elevate the risk of musculoskeletal pain, including neck pain.

Exercises that can be done from home, can reduce the risk of future episodes of neck pain. These exercises combined with Osteopathic care, can significantly reduce episodes of neck pain, or even stop them from happening at all.

A study that included almost 100 senior patients was undertaken over a six month period, primarily of older adults with a rounding of the mid back and with a bent forward posture. This resulted in findings that a one-hour, three times a week exercise program provided both improved spinal curvature and self-esteem.*

Two groups of young adults with rounded shoulder posture were included in a study that found that shoulder stabilisation and shoulder stretching exercises, resulted in physical benefits in many different ways. This implies that the combination of these exercises may be the best approach to improving posture, strength, balance and flexibility.

Another study showed that scapular stabilization exercises when combined with abdominal bracing exercises, produced greater physical benefits than just scapular stabilization exercise on their own.

It has also been witnessed in a recent  study, that when teenagers incorporate specific neck and shoulder exercises into their physical education, for a 16 week period, their posture improves significantly.

In 2008, the Neck Pain Task Force** suggested exercise for  the management of neck pain, as well as neck pain connected with a whiplash injury. A 2016 literature review published that exercise is also successful for improving grade III whiplash and neck pain. Furthermore, of injury that includes loss of neurological function. One thing that was of note, the review didn’t find any one set of exercises to be more beneficial than another. This suggested that combining several, various exercise routines may be the best advise an Osteopath can give.

Osteopaths are highly skilled in manual therapies, exercise training, and functional assessments – all of which have been found to successfully improve outcomes for patients with persistent neck pain. As with many conditions, treatment of early onset symptoms, yields the best results, so don’t delay in starting your Osteopathic treatment at an Osteopath near you!



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Knee Pain

Hip Exercises to Help Knee Pain

The hip and knee from a functionality perspective are very closely connected. There are many muscles that attach above the hip and below the knee joint. So, depending on the position or activity, the same muscle can move the hip and the knee. This close association crosses over in dysfunction as well, as patients with knee pain move differently, and the hip joint is primarily affected. But which one is the instigator, the hip or the knee?

In an attempt to answer the query, an investigation into patients with patellofemoral pain (PFP) who didn’t have hip pain, were asked to carryout either knee or hip exercises. Each set consisted of nine men and nine women.

The knee exercise group carried out quadricep or knee strengthening exercises while the hip exercise group undertook in hip strengthening exercises. The specific hip exercises included hip abduction (outward resistance) and hip external rotation muscle strengthening exercises. Both groups performed their exercises three times a week for eight weeks.

Interestingly, all participants noted a reduction in pain and improved function; however, the patients in the hip exercise group reported greater improvements than those in the knee exercise group. These results persisted for the next six months.

Why did hip exercises help patients with PFP knee pain more so than knee-specific exercises? Weight-bearing dynamic imaging studies have shown that patients with PFP knee pain frequently have a lateral or outward displacement of the kneecap, as well as lateral tilt due to femur/hip internal rotation (IR) rather than just abnormal patella motion due to muscle imbalance.

Other recently published biomechanical reports stated that patients with PFP demonstrate excessive internal rotation and adduction (inwards positioning) of the hip that isn’t generally found in pain-free subjects. Furthermore, those with PFP usually have weak hip abductors, extensors, and external rotator muscles than pain-free individuals.

Osteopathic treatment focuses on whole body care, and patients are often surprised that Osteopaths frequently treat hip, knee, ankle, and foot conditions. Initial patients examinations frequently reveal abnormal movement patterns, pelvic rotation, lower lumbar spine dysfunction, leg length discrepancy and that may contribute to a patient’s main complaint. Often, treatment must address these issues for the patient to achieve a successful outcome.

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Carpal Tunnel Syndrome

An Osteopathic Approach to Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a condition that happens when stress on median nerve passes through the wrist creating symptoms such as weakness, tingling or numbness. Surgery usually isn’t required initially, unless there is some cause for emergency action as a result of, for example, a broken wrist. In the main, Osteopaths will recommend perusing all non-surgical practises before consulting a surgeon.

So what happens when you contact an Osteopath for CTS?

First we will qualify existing symptoms and health history. The information you proved enables us to understand more about the intensity and frequency of your symptoms. Understanding a patients history we can understand better elements that are known to contribute to an increased risk for CTS. These elements could be such as hypothyroid, pregnancy, the pill and diabetes.

Next the Osteopath will carry out a thorough inspection, most prominently of the median nerve. The median nerve comes from the spinal cord in the neck as nerve roots meander down through the shoulder, beyond the elbow through to the wrist. If at any point along this journey the nerve is compressed, a patient could possibly feel CTS-like symptoms, so it’s paramount to locate whereabouts the nerve is “pinched” in order to ensure the best possible outcome for treatment.

It can be a very complex issue as the median nerve can be compressed at several points. This can be referred to as a double or multiple crush syndrome. Furthermore, the median nerve isn’t solely the nerve that creates this sensation to the hand. When entrapped, the ulnar and radial nerves can also result in these symptoms in the hand and can be mistaken for CTS by the Osteopath because it’s the most commonly known peripheral neuropathy.

Once all the possibly contributing factors are ruled out and a patients hand and wrist symptoms are identified, the Osteopath will advise a course of treatment that may include manipulation, mobilization, therapeutic exercises, modalities, wrist splinting, and even dietary recommendations, depending on the patient’s unique situation. Sometimes anti inflammatory foods can help. The overriding aim is to reduce pressure on the median nerve by restoring normal motion in the affected joints, as well as in reducing inflammation that may be a result of a variety of causes.

While patients with more extreme cases of CTS can be aided from non-surgical approaches, like Osteopathic care, it’s important to be mindful that it may take longer for such patients to experience improvements in pain and disability, and Osteopaths may not be able to completely reverse the disease if it is too advanced. The sooner a patient seeks care, the better their chance for achieving a desired outcome.

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