Looking forward to the weekend and joining the course on Headache Skills at the University College of Osteopathy. For those who are aware this is one of my favourite areas of treatment. I have spent many hours recently refreshing the Third edition of International Classification of Headaches- (ICHD-3). The breadth of understanding and classification has come a very long way in the last 15 years. We are very capable of affecting many of the sources of the Tension type -headaches both primary and secondary. However it is of prime importance as an Osteopath to be fully aware of all the classifications and work with a multi-disciplinary approach. I hope to produce an updated review sometime soon for the headache section of the website.
Further to the evolving situation regarding the COVID-19 outbreak and in line with Public Health England and other informed sources, I would like to assure patients that I am taking measures to reduce the risk of infection by implementing the following:
1) Pre-screening patients prior to visiting and advising to postpone appointments, stay indoors and avoiding contact with other people if you’ve travelled to the UK from:
Hubei province in China in the last 14 days, even if you do not have symptoms
other parts of mainland China or South Korea, Hong Kong, Japan, Macau, Malaysia, Singapore, Taiwan or Thailand in the last 14 days and have a cough, high temperature or shortness of breath (even if your symptoms are mild)
other parts of northern Italy (anywhere north of Pisa, Florence and Rimini), Cambodia, Laos, Myanmar or Vietnam since 19 February and have a cough, high temperature or shortness of breath (even if your symptoms are mild)
2) Asking patients to postpone appointments if they have symptoms of flu, even if they haven’t travelled
3) Continuing to maintain a high level of cleanliness and hygiene in my clinic both in public areas and in-clinic rooms, in line with the health and safety legislation
In light of the virulent nature of Coronavirus, I hope you can understand the importance of implementing the above measures.
If you have any questions, please feel free to email or call and ask.
In today’s world the nature of our lifestyle is much less active. We have, over the last few years become much more sedentary.
This is mainly due to the advances in technology. Sitting becomes the most commonly performed action. We no longer need to stand up and take down files or even go to the fax and copy machines. We do it all on our PC and more than ever our smart phones.
When we sit with our knees bent, the three hamstring muscles relax, they attach on our ‘sit bones’ (ischial tuberosities) and partly the back of the Femur. At the other end they attach below the inside and outside of the knee. They are, in essence a postural muscle responsible for controlling the strong quadriceps on the front of our legs. They need to remain in a state of constant readiness, called resting tone. If shortened for any length of time, small receptors in the muscles called ‘muscle spindles’ measure their length, send messages via the spinal cord to the cerebellum to reduce the actual resting tone length.
This is why after being seated for any length of time at a desk or in a car, plane, train or sofa, the act of standing become difficult as the muscles have become shortened. Stretching helps to re-set the resting tone to be longer again and also improve speeds and stride length when training.
Does Stretching Help?
Many patients ask about the benefits of stretching and whether or not it may help with their back problems. We will attempt here to explain the various benefits and disadvantages to be aware of within yourself, that may make Stretching part of your daily activities.
Recommended Daily stretches
Hamstrings, Hip Flexors, Gluteals, Calves, Neck muscles. For more details visit the following five pages on differing body areas for stretching.
Other muscles commonly shortened
In the side of the neck when holding the telephone for long calls regularly, ladies check out the raised muscles when trying on that nice summer dress that always slips of the shoulder. The back of the neck when slouching on your chair gazing at the lap top or screen that is too far away from you. A classic for developing that headache that comes on later in the day! Those Psoas or Hip flexors that attach fom the inside of your upper leg, head through the and under your tummy vessels to a fix to the front of the lumbar veterbrae, when you stand up they are tight and create a bigger dip in your low back, this can make your tummy look larger and bloated. Wearing High Heals shortens the calf muscles making wearing flat sandal painful in the achilles tendon.
Is it wise to see an Osteopath before starting regular stretches?
Probably a good thing as the osteopath will be able to assess the quality of the muscles and their respective functions. This allows the osteopath to advise which stretches are more beneficial and specific to you and the envirnment you are in.
The Osteopath
When visiting an Osteopath with chronic or acute problems, you are assessed and treated with a view to prevention of further injury, combined with corrective exercise. The Osteopath is empathetic to the patient’s need to establish a speedy recovery of the body and return to the achievement of intended goals.
A ‘trapped nerve’ is a common and unpleasant condition in which a nerve can be irritated by either the chemical or mechanic effects of inflammed tissues. Symptoms that may suggest that you have trapped nerve include:
Neck pain and stiffness with a combination of radiating pain, tingling, numbness and weakness down the arm, forearm and fingers
Low back pain and stiffness, also, with a combination of radiating pain, tingling, numbness and weakness down the buttock, thigh, legs and feet.
A typical case history of a patient presenting with a trapped nerve may sound like this:
‘I woke up one morning with an incredibly stiff neck. I could hardly turn it. It took me a lot longer to get changed for work – brushing my teeth, putting my jacket on and reaching for things were particularly painful. I took some Nurofen which seemed to free off my neck a bit but later in the day, I started to get a pain down my arm and a couple of my fingers went numb. Although the stiffness has improved somewhat, I’m still getting these symptoms down my arm 3 days on.’
Sciatica is another example of a trapped nerve. Sciatica can be caused by a number of different injuries such as a slipped disc, arthritis, a sacro-iliac injury or a muscle tear in the low back.
Because there are many injuries that can cause a ‘trapped nerve’ it it worthwhile visiting an Osteopath to determine the root cause of the symptoms. If the Osteopath is unsure, you may be referred to have an x-ray, MRI scan or ultrasound to confirm the diagnosis.
Once a diagnosis is made, a treatment plan can be created that will firstly reduce the pain and discomfort and secondly help to prevent recurrence of the injury.
There has been some press recently on tinnitus and it’s affects on Mental health. I have been approached on several occasions to ask am I able to treat this phenomenon with Cranial Osteopathy. Here is my response to the enquiry.
I have been a long term sufferer of Tinnitus for as many years as I can remember. My mother also suffered along with sinus issues. Over the years of living with this I have yet to discover a finite “cure.” I have however using some techniques reduced the severity to background irritation. I will point out that this has not removed it but made it less noticeable.
It is irritating for that should a patient discuss their tinnitus I will immediately be aware of my own.
What would I be looking for to help? Primarily as an Osteopath and Cranial Osteopath the first thing would be to assess the function of fluid flow within the head by gently holding the cranium in the palm of my hands and perhaps the sacrum. Once I have a good feel of what is happening I will be looking for any restrictions that may be affected ting the flow, ie structure attached to the various cranial bone from the neck back and Pelvis. I would then assess all the sutures of the cranial bones and the upper segments of the Cervical Spine. Of particular interest is the Sphenoid bone in the picture which houses the Vestibular and heating apparatus.
Sphenoid Bone
If there are restrictions in ay of these areas it may cause reduced functionality of the cerebra spinal fluid movement, blood supply and venous drainage. All of these can contribute to increased cranial pressure in turn headaches poor sinus drainage and venous drainage.
After treating these areas we return to assessing the flow. Hopefully this will enable the body to normalise. This will enable improved movement.
There are times when I suffer, that I will concentrate on good breathing technique whilst quietly listening to gentle classical music. Improving diaphragmatic function also improves flow within the cranium as there is a large fascial attachment from the diaphragm to the Cranial base of Sphenoid and Occiput bones. If the diaphragm is restricted it can affect all sinus drainage and Cranial function.
How successful this approach can be is never a guarantee. However it is not invasive and uses no drugs.
The difference between Osteopathy and Chiropractic.
Osteopathy and Chiropractic are very similar disciplines.
In the UK both are statutorily regulated with their own Acts of Parliament and their own General Councils
There is therefore a huge overlap of both these disciplines with a large portion of their workload being very similar
Diagnosis
Chiropractors tend to use more diagnostic procedures, such as x-rays and MRI scans, blood and urine tests.
Case history taking and orthopaedic examination are very similar for both professions and both use movement palpation (feeling the spine as it moves) to assist in diagnosing where there are abnormalities of movement.
Treatment
Around 50% of patients consulting an Osteopath receive manipulation combined with soft tissue, stretching and mobilisation whereas about 90% of patients receive a similar treatment called an “adjustment” if they consult a Chiropractor.
When a patient is manipulated or adjusted, the joint is moved just beyond its normal range of movement in an attempt to restore normal function. This obviously has to be done without spraining the joint and this is one of the many skills that Chiropractors and Osteopaths spend several years learning when training.
Mobilisation, which consists of stretching the joint rhythmically within its normal range of movement, is used more by Osteopaths than Chiropractors.
Both disciplines have similar methods of treating muscular, postural, cranial and paediatric problems, though the terminology used by each profession is different.
Regulators
General Chiropractic Council 44 Wicklow Street
London
WC1X 9HL
The General Osteopathic Council Osteopathy House,
176 Tower Bridge Road, London, SE1 3LU Telephone: 020 7357 6655
Website: www.osteopathy.org.uk
Qualifications
Chiropractic is a statutorily self-regulated profession – that is, chiropractors, like doctors and dentists, must be registered with the government appointed regulator, the General Chiropractic Council (GCC). It is illegal to practise as a chiropractor without being registered with the GCC. In order to achieve registration, practitioners must graduate with either a Bachelors or Masters degree in Chiropractic and the names of the degrees may vary depending on the awarding University. Registration with the regulator means that the individual has a properly approved chiropractic qualification, current professional indemnity insurance and is subject to the GCC professional code of practice and standard of proficiency.
Osteopathy is a statutory self-regulated profession as above and it is an offence for anyone to describe himself or herself as an osteopath and practise as such, unless registered with the General Osteopathic Council. Training takes between four and five years. Osteopaths use the letters DO, or BSc (Hons)(Ost) or BSc (Ost) or MSc (Ost) after their name.
Elbow pain can be caused by many problems. A common cause in adults is tendonitis.This is inflammation and injury to the tendons, which are soft tissues that attach muscle to bone.
People who play racquet sports are most likely to injure the tendons on the outside of the elbow. This condition is commonly called tennis elbow. Golfers are more likely to injure the tendons on the inside of the elbow.
Other common causes of elbow tendinitis are gardening, playing sports gripping small handles ie racquets, horse riding reigns, fly fishing rod handles, using a screwdriver, driving a car with thin steering wheel or overusing your wrist and arm.
Young children commonly develop “nursemaid elbow,” which often occurs when someone is pulling on their straightened arm. The bones are stretched apart momentarily and a ligament slips in between. It becomes trapped when the bones try to snap back into place. As a result, the child will usually quietly refuse to use the arm, but often cries out when they try to bend or straighten the elbow. This condition is also called an elbow subluxation (a partial dislocation.). This often gets better on its own when the ligament slips back into place. Surgery is usually not needed.
Other common causes of elbow pain are:
Bursitis — inflammation of a fluid-filled cushion beneath the skin
Arthritis — narrowing of the joint space and loss of cartilage in the elbow
Elbow strains
Infection of the elbow
Tendon tears — biceps rupture
Home Care
Gently try to move the elbow and increase your range of motion. If this hurts or you cannot move the elbow, call your health care provider.
When to Contact a Professional
Call your medical professional:
You have a prolonged case of tendinitis that doesn’t improve with home care.
The pain is due to a direct elbow injury.
There is obvious deformity.
You can’t use the elbow.
You have fever or swelling and redness of your elbow.
Your elbow is locked and can’t straighten or bend.
A child has elbow pain.
What to Expect at Your Clinic Visit
Your Osteopath will examine you and carefully check your elbow. You will be asked about your medical history and symptoms such as:
Are both elbows affected?
Does the pain shift from the elbow to other joints?
Is the pain over the outside bony prominence of the elbow?
Did the pain begin suddenly and severely?
Did the pain begin slowly and mildly and then get worse?
Is the pain getting better on its own?
Did the pain begin after an injury?
What makes the pain better or worse?
Is there pain that goes from the elbow down to the hand?
