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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

Adapted article – credit: https://www.drmatthewdunnonline.com/1603/hip-problem-back-problem–or-both-/

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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!

*https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5659804/

**https://journals.lww.com/spinejournal/Fulltext/2008/02151/The_Bone_and_Joint_Decade_2000_2010_Task_Force_on.4.aspx

Adapted article, credit: https://chiro-trust.org/neck-pain/exercise-posture-training-neck-pain/

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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.

Adapted Article: Credit https://chiro-trust.org/joint-pain/hip-exercises-help-knee-pain-seriously/

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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.

Adapted article, credit: https://chiro-trust.org/carpal-tunnel-syndrome/chiropractic-approach-carpal-tunnel-syndrome/
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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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