Friday, 29 July 2016

How much do you use your thumb? De Quervain's Tenosynovitis

How much do you think you use your thumb? 

Evolutionarily, it's one of the things that's made us humans more advanced than other species. But do you ever think of how much work it does? Maybe not, until it's in pain. Then every time you move your arm, fill the kettle, hold a coffee cup, write with a pen, get dressed or carry a bag -- you realise your thumb is doing a lot of work. 

I've recently had a patient in my clinic with De Quervain's Tenosynovitis -- fancy name for a condition of the tendons running into the thumb. It's not primarily a condition of inflammation, but more of a mechanical change in the tendons and the coverings of those tendons. A tendon is surrounded by a sheath, which helps it glide, move, and reduce friction. 

The cause of this condition is unknown, but it is thought to be linked to overuse of the area (i.e.: texting, mobile phone usage, repetitive use, and occupations that require gripping & twisting with the hand. 

Many believe that this condition is an inflammation of the tendons and their sheaths. However, the pathophysiology is more that of a cellular thickening of those tendons and their sheaths with gradual degenerative changes too.  

This can be a slow condition to completely resolve, but it does respond to osteopathy. It's important to address the biomechanics and altered positioning of the upper limb, any restrictions in the Thoracic and Cervical spines, and myofascial adhesions and trigger points in the forearm muscles. I also use acupuncture (in the Lung Meridian) and RockTape to support the healing. 

As with any condition, using hands-on manual techniques isn't enough. Once the acute pain stage has lessened, it's of utmost importance to to get the patient into a rehabilitative exercise program to prevent the recurrence of the condition. 

If you suffer with pain on the thumb-side of your hand/wrist, have any burning sensations in your hand, muscle spasms, swelling, or difficulty using your hand, have it checked out by your osteopath. 

Saturday, 15 August 2015

Osteopathic Vocabulary: Defined.

Osteopaths are experts in the human body. We use terms relating to movement, anatomy, and health in an everyday manner and forget that not everyone has the same vocabulary! It's important -- as an expert in any field -- to be able to explain your work to people that don't have the same vocabulary. So in this blog post, I'm going to define some of the most commonly used terms in an osteopathic clinic -- just in case I forget you don't know what I'm talking about!

Soft Tissues
This term refers to all the muscles, tendons, ligaments, and connective tissue that hold us together. They're basically the rest of the stuff other than bones and organs. The majority of injuries that I see in clinic are to the soft tissues. As they don't show up on XRAY, this type of test won't diagnose damage to them. Damage to the soft tissues is usually diagnosed clinically (via a specialist like an osteopath) or an MRI scan. 

Fascia is everything in the human body!! It's the connective tissue that makes everything continuous in our bodies. In life, it's a very fluid substance and has recently been shown to help transmit nerve and sensory signals through the body. It helps all our soft tissues move and glide around with ease. If we are dehydrated, have poor nutrition or poor health, the fascia can get sticky and stuck in place. This is also the case after an injury or prolonged postural changes. So then when we do try move in a particular way, you might feel a painful pull in one area, which is usually where the fascia is stuck down.

Adhesions occur in the fascia, muscles, and usually close to where these attach to the bones. If there is an trauma in the body, you will get some scar tissue, which makes the fascia less able to glide around. So these areas where the fascia gets sticky and stuck down are called adhesions. It's important to address these adhesions with osteopathic treatment, as overtime they can restrict movement of the soft tissues and of joints. 

Trigger Points
Trigger Points are muscles knots. They have a nerve centre, so they can refer pain to areas of the body far away from the source. Even though trigger points seem like nothing, they can be very painful -- trigger points in your chest muscles can even mimic a heart attack! They are easy to treat and respond well to myofascial release and acupuncture needling.  

Myofascial Release
This is one of my favourite types of treatment. It's more than just a massage, and it works deeper on the reflex mechanisms within muscles and the fascia. It uses deep steady pressure with some rhythmical joint movements to relax muscles and help the fascia to unstick and glide with more ease. 

This treatment technique works to get joints moving easier. It focuses on the joint level, and uses slow rhythmical movements to increase movemet. It can start gentle and become stronger, as the body responds to the treatment and allows it. Mobilisations stimulate special nerve receptors within the ligaments, tendons, and muscles around the joint, which send messages back to the brain for improving movement. 

In the osteopathy world, the term manipulation is used in reference to 'the clicking' technique. The technical term is 'High Velocity Low Amplitude Thrust' and it uses a fast impulse movement to help get a joint moving. Sometimes there is an audible 'pop' which is just the release of gases from the joint space. With this HVT technique, a large number of nerve signals is sent to the brain from that area of that area of the spinal cord, and this helps reset the circuits of pain and stiffness. 

Flexion / Extension / Rotation / Side Bending
These terms refer to how you move. 

Flexion of the spine is when you bend forward (as to tie your shoe), whereas flexion of the knee is when you bend it bringing your foot towards your bum.

Extension of the spine is when you lean backwards (as to look up to the ceiling), whereas extension of the knee is bringing it back to straight.

Rotation is when you twist, which is a very important movement in the spine -- especially in sports like tennis, golf, cricket and football. There is very little rotation in joints like the elbow and knee, but it's big in the hip.

Side-bending in the spine is when you...well...bend from side to side!!

In life, functional-dynamic movement occurs with all of these movements happening together, so it's important to be flexible in all directions. 

Wednesday, 29 July 2015

Common Causes of Knee Pain

Not all knee pain is created equal.

We are constantly seeing stories in the news about professional athletes with knees problems. Most of the time the footballer has slid, tackled and ruptured their ACL (anterior cruciate ligament) or the tennis player has torn their meniscus. So it's no wonder many of the patients I see in the clinic believe these are the reasons behind their knee pain. However, ruptured cruciate ligaments and torn menisci are fairly rare in the general population. Knee pain is not. 

The knee joint is a complicated, yet very stable joint and works as a function of both the spine/hips and the foot/ankle. Osteopaths will always examine the entire "chain," to see whether your knee pain is resulting from the top down (as a function of the low back/hips) or from the bottom up (as a function of the foot/ankle). 

Most commonly, patients come to my clinic with knee pain that's a result of compressive forces across the joint (yup, that's physics speak!). Both the quadriceps muslces (front of the thigh) and the hamstring muscles (back of the thigh) attach below the knee, so when they are tight (which they almost always are) they exert a compressive force across the knee joint. This tightness decreases the space in the knee joint, which means the structures around the joint can rub and pinch more easily. If these muscles around the thigh and knee are out of balance, they will pull more on one side of the knee bringing the joint out of alignment.

The patella - your kneecap - sits within the tendon of your quadriceps and glides back and forth across the knee joint as the quads contract. It's like a train on a traintrack and often gets 'derailed.' If any of the muscles around the knee (quads/hamstrings/IT band) are pulling the knee out of alignment, then the patella gets pulled off its track and can cause pain. This is called Patellar Maltracking. 

It is also common to strain the ligaments around the knee, without fully rupturing them. This can happen if you over extend your knee or make a sideways movement with a planted foot. Often there will be some swelling in a sprained ligament, just like if you were to sprain your ankle. 

Although there are many different causes of knee pain, I have outlined only a few - which are the most common I see on a daily basis. Knees respond very well to osteopathic treatment, relieving pressure, tension and tightness whilst also working up and down the chain - from the foot up to the spine - to ensure the movement and forces going through the spine are evenly distributed. 

Just remember, osteopathy is NOT JUST BACKS, so next time your knee is niggling, perhaps call your osteopath to see if they can help. 

Tuesday, 28 July 2015

Osteopathy: Treatment vs. Prevention


Treatment versus Prevention

Pretty much all of my patients come to the clinic because they're in pain and their body's have hit a crisis point. Perhaps they hit the gym too hard, slept awkwardly, spent too many hours hunched over the computer, or had a specific accident that left them needing some osteopathic TLC. 

Osteopathy works wonders to relieve pain, restore movement and flexibility to stiff joints and to help your body out of that crisis back to a place where you can enjoy your favourite hobbies. 

Most of the time, once a patient is pain-free, they cease treatment and only call the clinic if the problem reoccurs. However, I'm forever explaining to patients the power of prevention. At the end of the day, our bodies are machines that require maintenance and the occasional oil change, just like you would your car. 

Osteopathy is as beneficial in preventing recurrences of pain, as it is in treating and curing them. The manual techniques osteopaths employ help relieve tension in the body (that builds up from our 21st century lifestyles!), relax muscles which ultimately pull joints out of alignment, and teaches you how to recognise and manage triggers which can worsen your pain. 

We all lead busy hectic lives, sitting for too long and carrying heavy bags, whilst doing our best to keep fit and healthy. But sometimes our bodies run on empty and require that maintenance to prevent a much worse problem from occurring.  

So next time you start feeling a little niggle or have an important trip coming up, it's much better to book an appointment with your osteopath to sort it out early, so that it doesn't develop into a bigger problem. 

Tuesday, 24 March 2015

What is the click? Manipulations explained....

Osteopaths and chiropractors alike are often known 
for "the click." 

But what exactly is that sound you hear?

In technical terms, it's called a High Velocity Low Amplitude Thrust (HVT for short), but we often refer to it as "a manipulation."  It's an important tool in our osteopathic toolbox....but by no means the only one! 

We take a joint past the point where it's stuck and use a short/quick impulse to get the joint moving again. This helps evenly distribute movement and forces through the spine. The sound you hear is just gases releasing from the joint space, much the same as if you were to crack your knuckles. At the same time, a bombardment of nerve signals is sent back to the brain from that level in the spinal cord, which helps to reset the circuits of pain and dysfunction in the area. 

These manipulations are often scary for people, but despite the sound you hear they are not painful and hugely beneficial for your healing process. However, your osteopath will have already evaluated whether the technique is necessary, appropriate, and safe for the patient in each session. And osteopaths use a whole host of other soft tissue and myofascial release techniques, so don't rely solely on the manipulations!

Saturday, 30 August 2014

Back to School ... tips to help your children

As August is coming to an end, there's one main thing on most people's minds: back-to-school! The summer holidays seem to pass by so quickly, but for many it now means getting back into regular routines for both kids and parents alike. Routines are important for all of us, to help manage time, money, relationships, sleep cycles, eating habits, exercise and our health. 

We often bundle the kids off to school in the same manner as we bundle ourselves off to work: rushed, tired, and laden with bags, then expected to sit and concentrate for 8 hours in uncomfortable chairs. Read these few tips to help with your child's ergonomics, to ensure and happy & healthy return to school. Don't forget, they can suffer from back pain too...but can't make sense of it the way we do!

Choosing a backpack:

  • choose lightweight material & discourage clipping on toys to reduce the overall weight
  • make sure the shoulder straps are thickly padded
  • a backpack with multiple compartments helps distribute the weight
  • a backpack with a waist-strap can help take the load off the shoulders/back

How to wear the backpack:

  • adjust the backpack so it sits no more than 4" below their waistline. you don't want the pack hanging too far down their back & hanging past their bottom. the bottom of the bag should be sitting in the curve of their lower back
  • really encourage your kids to wear the backpack on both shoulders, to avoid unnecessary strain, as using it on one shoulder only can cause curvatures of the spine and back strain
  • load the heaviest items first, so they are closest to the spine and not creating a top-heavy scenario

Other ideas:
  • cut down on what's being carried each day. only take what's really necessary and leave the rest at home or in their locker (this goes you too mum & dad!)
  • encourage your kids to leave heavy hard-back books at school, if they're able to finish up their assignment at school
  • do a weekly "clear-out" of your child's bag, to get rid of all the miscellaneous bits they pick up & stash 
  • weigh the backpack regularly to ensure its within the safety weight range (15% of your child's body weight)
  • if they carry sports kit/equipment, have them carry it in both hands to distribute the load
  • well-fitting, supportive shoes are imperative to your child's development. choose soft pliable shoes, with enough room in the toes to wiggle. and make sure you measure their feet EVERY time you buy shoes, as they are constantly growing
  • encourage some form of exercise after school so that your child doesn't move from sitting-to-sitting
  • AND MOST IMPORTANTLY, encourage your child to talk to you about any aches or pains they may be experiencing. if they are suffering from any issues, get an osteopathic examination to ensure there's nothing more serious going on

Monday, 28 July 2014

Camping and Back Pain

Camping is a wonderful way to escape the city rat-race & get back to nature. Many of us are taking to it this time of year, helping to relieve stress & spend quality time with family and friends. 

But for back pain sufferers, the thought of sleeping under the stars can bring other anxieties! Camping can really wreak havoc on your back and neck, so take care & follow a few easy tips to ensure a fun break away:

Tips for preventing back pain when camping:

1) The long car/train journey to your destination can already set your back off. So take breaks whilst driving, and have a stroll to admire your surroundings before unloading your heavy items and setting up camp.

2) Don't carry too many heavy items...take multiple trips, park up as close to camp as possible, and delegate jobs to other people!

3) Take care whilst setting up the tent, get down onto the ground & kneel instead of crouching and stooping over.

4) Take chairs with you to sit around the camp, instead of crouching to the ground.

5) Use airbeds or a good quality camping mat instead of laying directly on the ground. Also, take your favourite pillow from home, to protect you neck.

6) Emergency single-use icepacks are beneficial to have on hand, just in case your back truly flares up.

7) And if you're already suffering from niggles, see your local osteopath for a check-up & treatment before you set off!