The lower back area and lumbar spine is one of the most common places to experience pain. Pain can range from stiffness, dull aches, and lack of mobility all the way through to debilitating pain. Affecting four out of five people at some stage, lower backache (often referred to as Lumbago) is one of the most common complaints treated by osteopaths.
Acute lower back pain can include sharp, intense and debilitating pain that may be accompanied by shooting pain into the legs. Many patients can find daily tasks such as walking up and down stairs, putting on shoes or socks, or getting in and out of chairs or cars difficult. Long term lower back pain can include stiffness, dull achy pain that may come and go or remain constantly in one location. In some cases, nothing changes this sensation, it may be constant no matter what position they are in. Other patients feel this sensation first thing in the morning or only when leaning forward or backward.
In the majority of cases low back pain is a result of long-term irritation to muscles, joints, or intervertebral discs in the back. This includes build-up of pressure from poor sitting postures, lifting techniques in manual jobs, or acute injury from an accident or sports. Even hobbies such as reading in bed or being slouched over a chair can provoke lower back pain.
Symptoms of lower back pain can include: constant pain (dull or strong) in the lower back region, pain bending forward to pick up objects or put on shoes and socks, pain leaning backward or manoeuvring in and out of cars, pain when coughing, laughing, sneezing, or when initiating bowel movements, pain on walking, sitting, standing, or during sports, weakness sensation in the legs or back, pins and needles or numbness in the legs, and sharp pain when sitting (this can be either hard surfaces or soft chairs).
Causes of Back Pain. Very often, back pain is caused by straining musculo-skeletal structures in the back (muscles, ligaments, joints, etc.). Although often painful, most of these cases are not serious if treated appropriately and quickly, and usually respond to osteopathic treatment.
Treatment of Lower Back Pain: The lower back is like the crossroads of the entire body, so it is important when assessing and diagnosing lower back pain that we also look at the upper back above, and the pelvis and legs below. This can help identify the root cause of the problem, as restrictions in movement in any of these areas can cause pain in the lower back to due increased demands of movement placed onto the back. To speed up the healing process, lots of people choose to have manual therapy, such as osteopathy. For chronic back pain (lasting more than six weeks) treatment typically involves a combination of painkillers, exercise and manual therapy. Spinal surgery is usually only considered when all else has failed.
If you have back pain, it is important to try to remain as active as possible and continue with your usual daily activities, as being inactive for extended periods of time is generally accepted as being bad for your back.
Some people may take painkillers, such as paracetamol or ibuprofen, or muscle relaxants to reduce spasms and to give back pain relief. Hot or cold compression packs may also help reduce the pain.
Altering the position in which you sleep can ease some of the strain on your back and ease the pain, so if you sleep on your side, try placing a pillow between your legs, or if you sleep on your back, place a pillow under the arch of your spine to maintain a comfortable position.
Trying to relax is a crucial part of easing the pain because muscle tension caused by worrying about your condition can make things worse.
Treatment and management of lower back pain will depend on what is found during the consultation, which category it falls into, and your individual presentation. Therefore, the treatment plan will be designed specifically for you.
Acute low back pain: often more gentle and slow techniques will ease the body out of the pain most effectively. The body appears to favour the ‘less is more’ approach at least when beginning the treatment plan. Once the body has let go of most of the pain and healed a lot of the damaged tissue treatments can be longer and involve more work.
Chronic lower back pain: often the pain becomes long term because the body has suffered for so long it tries to bury and ignore the back pain. Treatments will aim to resolve the root cause of the problem. In many cases only a handful of treatments are needed to resolve decades worth of backache.
Your osteopath will always complete a case history (questionnaire) about your condition, examine your spine, and include some more medical tests if necessary to ensure that osteopathy is the correct and appropriate treatment for you (e.g. test your reflexes, blood tests, etc.).
Before applying the gentle osteopathic techniques your osteopath will discuss your condition, explain the problem including the treatment and plan to help improve and resolve it. Exercises and advice on lifestyle and posture are often given when indicated.
Whether your back pain is coming from disc, joint, bone, muscle, or ligament, it is important that the treatment you receive results is a swift resolution to your pain.
It may be simple to avoid repetitive episodes, as back pain can be triggered by bad posture while sitting or standing, bending awkwardly, or lifting incorrectly.
Osteopaths are experts in treating and rehabilitating lower back pain, with excellent results. Treatment may include the following; osteopathic mobilisation techniques of the spine and pelvic joints both rhythmically and also some stronger pressure to release tight joints. Spinal manipulation, may also be employed to release particularly irritated joints. Soft tissue techniques to ease muscle tension and deep tissue techniques to release spasms in gluteal and low back related muscles. In many cases temporary adjustments in walking, sitting, standing and sport postures may need to be employed to encourage the body back to normal. Self-care advice will be given, including functional exercises, movements, and stretches that you can do at home to help manage the pain yourself and prevent the injury from returning.
If you are struggling with Sciatica symptoms it is important to seek out a registered qualified healthcare professional that can quickly help to give you pain relief.
Osteopaths have the training and expertise to be able to give you help and advice if you think you are suffering with sciatica symptoms.
Fast, safe and effective sciatica pain relief is key to allowing individuals suffering with symptoms a speedy recovery. We can usually accommodate more urgent appointments within 24 hours of enquiry.
What is Sciatica?
Sciatica is when the sciatic nerve is irritated. This nerve runs from your spinal cord, through your posterior hip, down the back of the leg, and into the feet. In many cases it usually gets better in 4 to 6 weeks but can last longer. Common causes of sciatica are postural related injuries, or activities such as lifting heavy objects, which can lead to the following:
Inter-vertebral disc bulges or prolapses, usually referred to as slipped discs: this is the most common cause of sciatica. When injured these can press on or irritate the nerves innervating the legs. The discs are essentially cushions used to absorb shock and movement between each bone in the spine. These discs however cannot slip. They are incredibly resilient and surrounded by amazingly strong ligaments connecting them to the spine. They can be injured; however, they do also heal. Slipped discs are most common in people who are between the ages of 30 and 50 years old. The condition affects twice as many men as women. Slipped discs often occur in the lower back. Although around a third of adults in the UK have lower back pain, less than 1 in 20 people have a slipped disc.
A slipped disc, also known as a prolapsed or herniated (bulging) disc, is where one of the discs in the spine ruptures and the gel inside leaks out.
If pressure is placed on the sciatic nerve it can cause:
• a lasting, aching pain
• a tingling sensation in one or both legs
Spinal stenosis/Inter-vertebral foraminal stenosis: is a narrowing of the spaces in the spine where the spinal cord, and nerves are located. It occurs when the bones, ligaments or discs of the spine squash the nerves of the spine (usually the sciatic nerve) causing pain, usually in the lower back and legs. It mainly affects people in their late middle age and older.
Causes of spinal stenosis include:
• age-related changes in the spine
• changes in the ligaments of the spine
• diseases of the bone, such as Paget’s disease
• a growth within the spine, such as a tumor
Spondylolisthesis: when one of the bones in the spine moves out of position, usually due to a fracture.
The piriformis muscle is a deep muscle located in your buttock region, with the sciatic nerve running beneath it. If this muscle is tight, tense, or spasms, it can irritate the sciatic nerve.
If you have Sciatica, you may have symptoms in your buttock/gluteal region, back of the leg(s), feet or toes. These symptoms can include pain (often travelling down the back of the leg), pins and needles or tingling, numbness, weakness, or lower back pain. These symptoms may get worse when moving, leaning forward, sneezing, coughing, straining on the toilet, or slumping in soft chairs. If you are experiencing these symptoms anywhere in the legs (or arms), and not just the areas listed above, it may well be caused by irritation to a nerve other than the sciatic nerve.
If you are experiencing loss of control of your bowel or bladder function, or severe loss of feeling or weakness in the legs, please seek emergency medical attention immediately.
When to seek emergency help
Seek immediate medical help by calling 999 or 112 (from a mobile) for an ambulance if you experience the following symptoms:
• numbness in your bottom, lower back and leg
• loss of bladder and/or bowel control
• feeling of weakness in your leg and foot
These symptoms may be signs of a rare condition known as cauda equina syndrome.
Diagnosis of Sciatica
We can diagnose a slipped disc from your symptoms and medical history. They may also carry out a physical examination to test:
• reflexes and straight leg raising test
• muscle strength
• walking ability
• sensation in your limbs
Depending on your symptoms, it may be necessary to have further tests, including:
• a blood test to rule out infections
• an x-ray
• imaging tests such as a CT or MRI scan
Treatment of Sciatica
Patients regularly present to osteopaths with symptoms such as sciatica, and in many cases, they can be managed through conservative treatment such as osteopathy. It is first important to diagnose the specific cause of the symptoms so that they may be managed accordingly. Management depends on each individual patient. Once a diagnosis has been made, and you are deemed safe for treatment, a combination of hands on manual treatment, along with specific stretches and exercises to perform at home is usually an effective way to manage the symptoms of sciatica. This may include gentle rhythmical movements of the spine, traction or gapping of the spinal joints, as well as treatment into the hips and upper back, with the aim to decrease the load placed onto the lower back. Medical acupuncture can also be used very effectively if the cause is deemed to be muscular, for example the piriformis muscle as detailed in causes above.
Surgery to release the compressed nerve and remove part of the disc may be considered (in severe cases), or if the pain continues for longer than six weeks. Surgical options include:
• lumbar decompression – where the part of the herniated disc pressing on your nerve is removed (this is the most common type of surgery required)
• fusion surgery – if a vertebra has slipped out of place, it may be possible to fuse it into place using a bone graft supported by metal rods
• laminectomy – a procedure often used to treat spinal stenosis, this removes or trims the arch of a vertebra to relieve the pressure on the nerves
However, in many cases, a slipped disc will eventually shrink back away from the nerve, and the pain will ease as the disc stops pressing on the affected nerve.
If you have a slipped disc, it is very important to keep active. Initially, moving may be difficult but after resting for a few days you should start to move around. This will help keep your back mobile and speed up your recovery.
Any exercise you do should be gentle and not put a strain on your back. Swimming is ideal because the water supports your weight and little strain is placed on your joints.
Your osteopath will guide you through the diagnosis and treatment plan to aim to alleviate your sciatic pain.
For persistent sciatica (known as chronic), you may be advised to try a structured exercise programme under the supervision of your osteopath involving sciatica stretches. Only in very severe cases, surgery may be needed to control the symptoms.
There are some steps you can take to minimise your risk of a slipped disc or back injury that could lead to sciatica. This includes:
• better posture and lifting techniques at work
• stretching before and after exercise
• simple, regular sciatica exercises to improve flexibility
Just ask your osteopath for advice.
Neck pain is a common complaint seen by osteopaths and is commonly associated with tension and sedentary lifestyles or seated work environments, which can cause bad posture (e.g. working with computers for prolonged periods). Lifestyles are becoming more sedentary and people are often forced to commit to long commutes to work; electronic devices have fast become part of the modern life; thus, neck pain is notably on the increase. And of course, neck pain is often a consequence of a ‘whiplash’ type of injury, sustained by a road traffic accident. Neck pain is a musculoskeletal disorder which can manifest itself in a number of ways. More often than not, neck pain is localised to the neck region itself, but it can be more widespread and travel into the shoulder and arms.
There are many factors that influence neck pain, these include: rotating the head to look behind you while driving, cycling or motorbiking, seated or standing posture, desk set up, use of laptops and tablets, working posture or repeated movements, head movements during running, walking, dancing, and many other sports.
Common causes of neck pain include muscle tightness, muscle fatigue, or gradual joint stiffness. However acute or sudden onset of neck pain is also common. Many people hold their tension in their necks; for example, shoulders will be shrugged up slightly or held tight whilst at work or driving. This results in over activation of the muscles leading to tightness and fatigue, which can slowly build up over time. Neck pain is also closely related with problems in the shoulders and upper back.
There are many causes of a stiff neck including the following…
• Muscular tension - this may be a primary problem with local muscles in the neck, such as a torn or strained muscle.
• Muscular spasm - often secondary to an underlying fault (e.g. joint inflammation), the brain causes local muscles in the area of injury to tighten up in order to “splint” the damaged region, allowing it time to recover.
• Ligament strain - usually traumatic in origin, sometimes ligaments get stretched which causes pain. An example of this might be a “whiplash” injury.
• Joint inflammation - we've all done it- woken up with a stiff neck following a poor posture overnight, or sitting at a computer for too long. If this causes the facet joints in the spine to sit too closely together, the surfaces may rub and become inflamed, resulting in pain and stiffness and usually spasm, causing neck muscle pain.
• Stress - tension itself can result in holding our postures in a “tight” manner, resulting in neck pain. Simple breathing or relaxation techniques can easily help in these cases.
• Wear and tear in joints - medically called “cervical spondylosis” occurs when joints become arthritic, resulting is some pain and stiffness. Cervical spondylosis occurs naturally with age. It does not always cause symptoms, although in some people the bone changes can cause neck stiffness.
• Trapped nerve - the nerves that exit the spinal cord in the neck may become compressed (e.g. by a bulging disc). This can cause muscle spasm, but often the pain is experienced in the arm or hand and may be accompanied by sensory changes (e.g. numbness or tingling) or some weakness. Neck pain caused by nerve entrapment is called cervical radiculopathy. It may occur after you have held your neck in an awkward position, after an unusual movement, or following the use of vibrating power tools.
• Poor posture - this can cause pressure onto certain joints and muscles resulting in them working inefficiently and lead to fatigue and pain.
• Torticollis (a twisted neck that feels painful and difficult to move) and often occurs spontaneously and for no apparent reason.
Symptoms of neck pain can include: stiffness, sharp or pinching sensation in the neck, headaches, pain looking over the shoulder, pain looking towards the floor or the ceiling, pain travelling into the arms or hands, pins and needles or numbness in the arms or hand. This usually indicates there is nerve compression from the neck or the muscles of the neck and shoulder. Symptoms such as this should really be properly assessed to identify the root of the problem.
It is common for people to suffer with headache in association with their neck pain. Sometimes this is due to compression of a nerve which supplies the back of the eye socket (orbit) and these people complain of a “forehead” headache.
It is rare that neck pain has a more serious cause, however if we feel it is appropriate then recommendation for onward referral will be made. It is important to us that our patients are managed appropriately to get the best possible outcome.
Treatment of Neck Pain. Hands on treatment will help to release tension in the muscles and joints of the neck, shoulders, and upper back. This may involve deep massage techniques, soft tissue work, joint mobilisation and manipulation techniques to improve the movement and function of the spine.
Exercises to improve mobility in the neck and upper back will often be given, as well as specifically targeting muscle weakness and imbalances. Postural advice related to your daily activities will usually be given, helping you to understand and manage the neck pain yourself and prevent recurrence.
Upper Back Pain
Upper back pain may be result from an injury or strain to the discs, spinal joints, muscles, ligaments, tendons, or fascial connections through this region. The upper and middle back has many structures influencing it, including the muscles and joints associated with the neck, rib cage, lower back, and shoulders. However, the posture the body holds can also be a result of changes to biomechanics originating from the hips, knees and feet. Pain can also be related to the mechanics of breathing as the ribcage is connected to the thoracic spine.
Causes and symptoms of upper back pain can include: pain travelling from the back to the chest, pain taking deep breaths, sharp or dull sensation around or between the shoulder blades, pain leaning forward or backwards to put shoes on or reach high shelves, pain raising the arms over head, pain during pushing or pulling movements or sports, pain when sitting for long periods, stiffness in the upper back, or upper back pain paired with neck pain or lower back pain.
Most causes of upper back pain are not serious; however, it can also be caused by referral from areas such as the heart, lungs, or stomach. Your safety is our priority, it is therefore important that a thorough case history be taken to aid in an accurate diagnosis, and any onward referrals made where appropriate.
Treatment of Upper Back Pain: Once the root cause of the problem has been located, your osteopath will begin working on the appropriate areas. The ideal shape of the spine is a thin ‘S’ where a small arch in the lower back is balanced by a small rounding of the upper back. If the lower back has an excessive arch then the upper back will have an excessive rounding, thus causing the head to fall forwards. Correcting the position of the lower back and neck will relieve much of the tension into the upper back, as well as improving your posture helping you to stand up straighter.
Treatment usually involves release of tension in the muscles of the upper back, rib cage, shoulders, and lower part of the neck. This may involve deep massage techniques, soft tissue work, as well as techniques to improve the movement and function of the spine and ribs such as osteopathic mobilisation and sometimes spinal manipulation.
Treatment plans for upper and mid back pain depend entirely on what is found during the consultation and follow up sessions. Corrective and rehabilitative exercises will be provided specific to each individual person, to help relieve their upper back pain and prevent it reoccurring.
More than 10 million people in the UK get headaches, making them one of the most common health complaints, but most are easily treated with osteopathy.
Simple mechanical headaches often come from tightness at the base of the skull/ top of the spine. These “cervicogenic” or tension headaches are commonly borne from a combination of muscle tightness and poor joint motion and may even involve entrapment of certain nerves which when compressed can cause pain. These are often called stress headache and may even cause symptoms of dizziness. Manipulative osteopathy is a good way to relax this tightness and ease the pain.
Causes of Headache
Tension headaches are the most common, and what we think of as normal everyday headaches.
They are referred to as Cervico-genic headaches and feel like a dull ache with constant pressure around the front, top and sides of the head as if a rubber band has been stretched around it and sometimes cause headache behind the eyes.
Stress is one cause, but there are lots of others, including drinking too much alcohol, not getting enough sleep, depression, skipping meals and becoming dehydrated.
Migraines are less common. If a severe headache is recurrent and disabling to the point of stopping you from carrying on with daily life, it may be a migraine.
People describe migraines as a pounding or throbbing pain on one or both sides of the head.
Most people treat their migraines successfully with over-the-counter medication. If they’re severe, however, you may need stronger migraine-specific medication that is only available on prescription from a doctor.
Cluster headaches are another type of primary headache. These excruciatingly painful headaches cause an intense pain around one eye. They're rare and are called cluster headaches because they happen in clusters for a month or two at a time around the same time of year and can feel like constant or persistent headache.
Pharmacy medications don't ease the symptoms of a cluster headache, but a doctor can prescribe specific treatments to ease the pain.
These include headaches that come on after drinking too much alcohol or after a head injury or concussion.
You may also get a headache when you’ve had:
• A cold
• The flu
• An allergic reaction
Medication and painkiller headaches
Some headaches are a side effect of taking a particular medication and frequent headaches can also be caused by taking too many painkillers.
Headaches in women are often caused by hormones, and many women notice a link with their periods. The Pill, the menopause and pregnancy are also potential triggers.
Temporo-mandibular joint disorders (Jaw pain)
Headaches are one of the symptoms of temporo-mandibular joint (TMJ) disorders which affect the joint between the lower jaw and the base of the skull.
It has been estimated that approximately 20-30% of the adult population will experience a TMJ disorder at some point.
Osteopathy can help successfully treat these TMJ dysfunctions.
Giant cell arteritis (temporal arteritis)
Giant cell arteritis (GCA) is a condition in which medium and large arteries, usually in the head and neck, become inflamed. It usually affects adults over 60 years old.
Giant cell arteritis should be regarded as a medical emergency and you should contact your GP immediately if you suddenly develop:
• a severe headache
• jaw pain when eating
• blurred or double vision
• a sore scalp
Other secondary causes of headache may originate from ears, eyes or teeth.
The osteopath will consider your symptoms, perform an examination to ascertain the cause of your headache to make a clinical diagnosis and formulate a treatment plan.
Treatment: Osteopathy can provide therapeutic rehabilitation of tension or cervico-genic headaches. A review of the medical literature suggests that the efficacy of physical treatment for the long-term prevention and control of headaches appears greatest in patients who are involved in ongoing exercise and physical conditioning programmes. Therefore, treatment plans will pair manual hands on osteopathic treatment with rehabilitation exercise programmes for the best possible outcomes.
Osteopathic manipulative techniques such as joint mobilisations, medical acupuncture, and muscle energy techniques are particularly well suited for the management of cervicogenic headache. Joint manipulation can be carefully used in some patients, which have shown great effect. Physical treatment techniques used by your osteopath are generally better tolerated when initiated with gentle muscle stretching and manual cervical traction.
The aim of this is to improve cervical mobility and encourage better posture, which should help to remove the factors that contribute to your headaches. Therapy can be then be slowly advanced as tolerated. Muscular trigger points are discreet hyperirritable regions of contracted muscle that have a lowered pain threshold and refer pain to distant sites in predictable and reproducible patterns. Treatment of these areas can aid therapeutic management of referred head or face pain from cervical muscular sources.
Most people will refer to their ‘rotator cuff’ muscles and usually these muscles and other structures in the shoulder do require attention during treatment. However, sometimes an area further away from the shoulder may not be moving as well, or contributing as much as it should, causing the shoulder to work more than is necessary. It is therefore important to assess the shoulder, along with other areas such as the shoulder blade, upper back, neck, and all associated muscles and nerves, that may be contributing to the shoulder injury to help identify the root of the problem. If any of the above mentioned areas are impacting the shoulders’ ability to recover and heal, then exercises and movements will be given to restore proper function.
Causes of Shoulder Pain
There are a number of reasons why you might be experiencing shoulder pain which include:
• Osteoarthritis - degenerative wear and tear in the shoulder joints.
• Poor posture- causing the shoulder to be held in a position causing stress to supporting muscles. This often causes a combination of neck and shoulder pain.
• Inflamed joint (frozen shoulder)- this is a painful condition that reduces normal movement in the joint and can sometimes prevent movement in the shoulder altogether.
• Rotator cuff damage – the rotator cuff is a group of supporting muscles that control the shoulder joint and maintain its stability.
• Shoulder instability (hypermobility) – where the shoulder may become unstable due to an unusually large range of movement.
• Acromioclavicular joint disorders – damage to the acromioclavicular (AC) joint, where the collar bone and shoulder blade meet.
• A broken (fractured) bone, such as the collarbone (clavicle) or upper arm bone (humerus).
• Shoulder blade pain – this often originates from an underlying rib, so accurate diagnosis is vital.
• Referred pain from elsewhere- sometimes heart, liver and gall bladder problems can refer symptoms to the shoulders, so a detailed case history is important to establish if the cause is mechanical or medical.
Treating shoulder pain When treating shoulder injury, the osteopath will use techniques that will include soft and deep tissue massage, osteopathic mobilisation, joint manipulations, and active mobilisations where the patient challenges their own body through movements to help restore joint coordination and control. Spinal, rib and shoulder manipulation techniques and acupuncture and ultrasound may be used in order to help maintain proper function. Depending on the cause of your shoulder pain, your osteopath may advise or refer you for other treatments such as;
• injections of corticosteroids
• avoiding activities that make your symptoms worse such as throwing
• using a wrapped ice pack for 5-10 minutes each hour
• painkillers & anti-inflammatories, e.g. over-the-counter paracetamol or ibuprofen or prescribed diclofenac or naproxen
• exercises to strengthen your shoulder
You should see your osteopaths or your GP if your pain is the result of a traumatic injury, it's particularly painful, or there is no sign of improvement after a few days.
Some shoulder pain can be a long-term problem: up to half of people still have symptoms after 18 months. A correct diagnosis will ensure you receive the right treatment and speed up this recovery period.
Common Shoulder Pain conditions
Frozen shoulder (adhesive capsulitis) occurs when there is thickening, swelling and tightening of the joint capsule, which surrounds the shoulder joint. This makes movement stiff and painful.
Frozen shoulder pain and symptoms can vary greatly but tend to advance slowly. They are usually felt in three stages, spread over an average of 18 months.
Most cases of frozen shoulder occur in people aged over 40. The condition is more common in women than in men, but as to the reason why- we are still unsure.
Tendonitis is inflammation (swelling) of a tendon.
Bursitis is inflammation of a bursa. A bursa is a small, fluid-filled sac usually found over the joints and between tendons and bones.
Tendonitis and bursitis often occur together. When the tendons or bursa are trapped between the bones it is often known as "impingement syndrome".
If the tendon is repeatedly scraped against the shoulder bones, it can gradually weaken and will sometimes tear tendon tears are most common in people aged over 40. Tears that affect younger people are usually caused by an accident. In older people, tears are often caused by impingement syndrome.
It is estimated that around half of people over the age of 60 may have partial or complete rotator cuff tears. This is because your tendons become weaker as you get older.
Shoulder instability usually occurs in people aged under 35 and can be either:
• traumatic – the shoulder is forced out of place by a sudden impact
• atraumatic – the shoulder gradually moves out of place over time.
Acromioclavicular joint disorders include:
• tearing or stretching the ligaments in your acromioclavicular joint – usually traumatic or from repetitive use
• partially or completely dislocating your acromioclavicular joint
• Osteoarthritic change to the joint through wear and tear.
Acromioclavicular joint disorders are more common in men and those between the ages of 20 and 50.
Arthritis is a common condition that causes pain, swelling, inflammation, and often stiffness in the joints of the body. The two most common types of arthritis are osteoarthritis and rheumatoid arthritis, but there are many other types including ankylosing spondylitis, gout, psoriatic arthritis and reactive arthritis. Certain types of arthritis can also affect children. Common areas affected include the hips, knees, feet, hands, and spine.
Everybody gets grey hair and wrinkles as we get older. In the same way, it is normal for our muscles, bones, joints and associated tissues to change as we age. Ageing does not necessarily mean that we will experience increased pain or stiffness. However, if this does become a problem, people often find that treatment and advice from an osteopath can complement GP care and pharmaceuticals management. If you do begin to notice problems, your osteopaths can work with you to keep you healthier, allowing you to enjoy the pleasures of life into your older years.
Causes and symptoms involved in arthritis: pain (this can be at rest or during movement), swelling that is sometimes associated with redness, stiffness or a creaking feeling in the joints which is often worse in the morning, decreased function of joints, weakness and muscle wasting, and difficulty doing some day to day activities.
Treatment: While osteopaths cannot ‘cure’ arthritis, we can help to reduce and manage the symptoms effectively. Gentle manipulative and massage techniques by osteopaths can help reduce the pain and symptoms experienced in many arthritis sufferers. Treatment is individual, gently moving and stretching an arthritic joint, massaging surrounding muscles and tissues to help ease discomfort, and help to move synovial fluid within the joint providing lubrication. It is important to fully understand how to manage the condition before it begins to affect our daily living tasks.
Rehabilitative exercises are a primary part of osteoarthritis care, therefore you will be guided through an exercise routine specific to you, to help get you moving. This will help by increasing your mobility and strength in the legs and arms, whilst reducing pain. You may also receive advice on your diet, posture and changes to lifestyle. X-rays, scans or other tests may sometimes be required however that is usually not the case.
150 minutes of exercise per week, in blocks of ten minutes or more can help to increase muscular strength, reduce the risk and falls, increase function and mobility, and reduce pain experienced in the joints from arthritis. This should be enough to make you warmer and breathe harder, whilst still being able to have a conversation. It can also help to improve your mood and levels of confidence. This might include activities such gentle squatting, dancing, or brisk walking. Your osteopath will often provide exercises to improve your balance, to reduce the risk of falling, particularly if you are over the age of 70.
Hip and Groin Pain
People who commonly experience hip pain include middle aged and elderly populations, sports people, or those who are on their feet or walking for large portions of the day. Hip pain can be provoked by lifting heavy objects from low off the ground, falls or spontaneous movements involving recovering from losing balance, or overreaching when running.
Chances of developing hip pain increases if the activity involves extending the leg back and using maximal muscle strength to drive the leg such as in: football, rugby, racket sports, martial arts, or athletics
Muscles strains, joint irritation, wear and tear, and prolonged standing or sitting are the most common causes of hip pain and may only require a short series of treatments to resolve the problem. Groin pain may be mistaken for hip pain as well, this will become clearer during the case history and assessment.
Causes and symptoms associated with hip pain:
- stiffness or restriction of movement,
- pain lifting the knee towards the chest or behind you,
- difficulty lifting the leg whilst walking up or down steps,
- difficulty going from seated to standing or standing to seated,
- sharp pain in the groin on certain leg movements,
- difficultly putting on socks and shoes,
- pain travelling down the back of leg to the knee or foot,
- pain travelling down the front and/or side of the leg to the knee,
- lower back pain or knee pain.
Treatment: The hip and groin area is a complex area to treat. Your osteopath can successfully treat patients who come with undiagnosed hip or groin pain regularly that has lasted for months or even years, despite scans, tests and various forms of treatment.
A key component of this treatment is the correction of hip biomechanics along with hands on treatment. Due to the close relationship of the ankle and knee mechanics with the hip, a detailed examination of the lower limb mechanics is also essential in identifying the root cause of the problem.
Examination of the lower back is also important as hip pain can be referred from the lower back.
Specific osteopathic joint mobilisation techniques will be used to improve the function of the hip joint to increase the range of motion. Manipulation may also be indicated to free up the hip ligaments. Many specific muscle contraction and relaxation sequences will enable the body to release tension in the hip and also rapidly improve muscle strains. Soft and deep tissue techniques may be used to reduce larger muscle strains and increase the speed of recovery.
Specific stretching and strengthening exercises may be advised to correct compensatory patterns and weaker muscle groups. Better muscle balance will reduce pain in the hip, whether this is through stretching tight muscles, or strengthening weaker muscles.
If there is a change in the lower leg mechanics, corrections will be made through exercise to help change movement patterns and relieve the hip pain.
Knee pain is very commonly seen in sports people and the elderly. More often than not knee pain is a result of either joint surface wear and tear due to repeated use, age, cartilage or meniscal damage through sporting injuries, muscle strains in the knee, thigh, hamstring, or calf regions, or irritation of the small fat pads called bursa that allow for muscles to glide freely over bone.
Arthritic pains, which gradually develop over years often, give rise to symptoms such as morning stiffness, pain walking and pain bending the knees.
If the knee does not have time to recover between intensive sessions of exercise/sports/competition then it may slowly become inflamed and irritated. If the knee has very sharp pain after a sport training session or game then the possibility of genuine ligament, cartilage or muscle damage becomes greater.
Rapid twisting or changing of directions may place stress these structures and require treatment. Muscle strains often result from overload of the muscles and tendons either from training, running, or competition situations.
These are clear because moving the joint will cause pain in the muscle each time and you will begin to avoid specific movements. Knee pain can also be referred from the lower back through compression of nerves that exit the spine or through the muscles controlling the hip.
Causes and symptoms of knee pain can include:
- sharp pain bending the knee,
- stiffness in the morning lasting up to 60 minutes,
- weakness sensation going up and down the stairs or when walking,
- locking or ‘catching’ of the knee,
- giving way in the knee,
- constant aching within the joint,
- grinding sensation within the knee,
- swelling or redness of the knee itself,
- associated hip or ankle pain.
Treatment and Management: Knee injuries can happen suddenly, or build up over time. Your osteopath can successfully treat knee pain caused by a variety of factors.
The knee is located between the hip and the ankle. These areas can therefore significantly impact the knee and in many cases are the root cause of knee pain.
After examination of the pelvis, hip, and ankle mechanics and movement, it will be evident if their involvement will require treatment.
If these areas require treatment this will be discussed with you.
Specific osteopathic mobilisation techniques and manipulation increase the mobility of the knee joint and improve the range of motion.
Mobilisations also help to pump inflammation out the knee joint and further aid healing. Restoring correct balance to the muscles of the thigh, hamstring and calf regions also help in reducing impact and strain to knee joint.
This can be done through both soft and deep tissue massage techniques.
Exercises to both increase the flexibility of the muscle groups surrounding the knee, and increase the strength may be required to improve knee function.
If the muscles are too tight or too weak then the knee must absorb much greater pressure and so the joint surfaces will become more easily inflamed.
Medical acupuncture and ultrasound therapy can be used by your osteopath to reduce inflammation and improve your rate of healing.
Elbow pain is most commonly seen through direct trauma to the arm or through repetitive movements. Examples of trauma include falling onto your arm, sports collisions, or injury while lifting heavy furniture or weights. Repetitive strain examples include sports such as tennis, squash, cricket; and jobs such as builders, brick layers, carpenters, and decorators.
Another major cause for elbow pain is desk related jobs that require lots of keyboard and mouse use, causing strain to the muscles that move the wrist and elbow. This could be through incorrect desk height set up, chair height, keyboard and mouse position, or frequency of use. This applies not only to the working population but anyone using laptops, computers, or gaming consoles for many hours in the day.
Elbow pain can also be caused from problems in the neck, upper back, or shoulder, travelling down to the elbow.
Often painful elbows are a result of wear and tear related inflammation of the associated arm and forearm muscles. Grip related tasks can become difficult in terms of pain and sensations of weakness. Gradually the arm, elbow or grip becomes less durable to the pain and so onset of pain or muscle fatigue becomes quicker.
Associated symptoms of elbow pain can include: constant ache or low-grade pain within the joint, sharp pain when gripping objects, weakness in holding objects, pain or inability to fully extend elbows, neck pain, shoulder pain, wrist pain.
Treatment: It is always incredibly important to assess the muscles and joints of the wrist, elbow, shoulder, neck and upper back. Elbow pain can be a result of nerve entrapment in the neck or shoulder, or as a result of muscle compensation from hand or shoulder problems.
Treatment will involve osteopathic mobilisation techniques to improve mobility of the joints that make up the elbow including manipulation techniques. Often a great deal of deep tissue massage is required to ease the tension in the forearm, upper arm, and shoulder to reduce elbow pain.
Strengthening or flexibility advice for the muscles associated with the wrist, forearm, shoulder or neck may be advised. This will depend on whether the elbow pain is caused by muscular weakness, or tightness.
Specific postural advice will also be given; whether it be sitting or desk based, the way in which you’re using your arms and shoulders during manual labour tasks and jobs, sports specific movements, and using musical instruments.
If you are suffering with elbow pain, book an appointment with your osteopath and let them help you out of pain.
Hand and Wrist Pain
Hand and wrist pain have many similar causes to elbow pain, these include fine and intricate movements such as writing, typing, and using a mouse; larger movements such as opening jars, gripping a screwdriver or sports equipment, and carrying heavy objects.
Problems in the hands may be caused by many different factors including ‘wear and tear’ and arthritic conditions, lack of blood flow to the fingers, trauma such as falling on an outstretched hand, or problems in the forearm, elbow, shoulder or neck. Pins and needles in the hands can be a result of nerve compression in the hand, forearm, upper arm, shoulder, neck muscles, the neck itself, diabetes, pregnancy or thyroid issues.
Causes and symptoms of hand & wrist pain can include: pins and needles or numbness in the hand or fingers, stiffness or difficulty bending the fingers or wrist, sharp pain when putting pressure down through the hands, difficulty holding objects including drinks or cutlery, stiffness lasting up to 60 minutes in the morning, to sharp pain when performing heavy tasks.
The hands are often the location for systemic symptoms to present such as pins and needles, swelling, or hypersensitivity to temperature changes. Your osteopath will take a thorough case history to rule out any more serious pathology before starting treatment.
Treatment: Osteopathy can be incredibly helpful in treating and managing hand & wrist pain. As mentioned above, a proper assessment of the hands, forearms, elbows, shoulder and neck will reveal the root cause of the symptoms in the hands.
Improving the mobility of the wrist and all associated joints through osteopathic mobilisation techniques can free up the muscle and nerve tension and improve blood flow through the hands. Manipulation techniques can also be used to improve joint alignment and reduce muscle tightness.
Grip strength and wrist mobilisation exercises may be given in order to improve strength, muscle endurance and stability of the wrist. Stretching advice may be given to promote ease of motion of the elbow, forearm and hand muscles.
Advice on how to make subtle modifications to your daily activities that may be irritating the area can also be given.
The foot and ankle are incredibly tough and durable joints. We spend our entire lives standing, walking, running and jumping on them and many of us won’t experience any foot pain at all. Foot pain is usually a result of footwear, joint sprains or injuries through accidents or sports, excessive repetitive stress, or referral from nerves in the spine.
The majority of sports people and athletes will have twisted or sprained their ankle at least once in their careers. Rapidly changing direction with the foot planted on the floor is often a cause for ankle sprain, as well as tripping on stairs or pavement edges. Ankle and foot pain can be very limiting and have a detrimental compensatory effect elsewhere in the body. It is usually easy to treat with osteopathic techniques.
Your osteopath will be able to help determine the cause of your pain, by questioning you about the onset of the symptoms and any previous history. Your osteopath will then examine your ankle and consider this in relation to the rest of your body to establish a biomechanical link, before formulating a treatment plan.
Causes and symptoms of foot & ankle pain can include:
- dull ache on the middle and outer ankle,
- pain pulling the toes up or pointing the toes down,
- tripping on pavements/stairs/doorways,
- difficulty going up or down stairs,
- tight calf muscles,
- pain between the toes,
- sharp or needle like pain under the foot during first steps in the morning,
- pins and needles or numbness in the toes or feet,
- cramping in the toes or feet.
Common conditions include:
- Sprained ankle- usually affecting the front ligament in the ankle, following a “rolled ankle” or inversion strain
- Fracture of the fibula or tibia- traumatic origin
- Dislocated ankle- where the bones move out of alignment at the joint
- Tendonitis- inflammation of the tendon of muscles where they attach to bone
- Muscle or tendon tear- e.g. Achilles Tendon damage
- Heel pain (calcaneal spur)- bony growth on the underside of the heel bone
- Plantar Fasciitis (sometimes known as policeman’s heel)- discomfort affecting the sole of the foot
- Bunions- deviation of the big toe. This is often a familial trait.
- Osteoarthrits- wear and tear of particular joints
- Gout- recurrent acute inflammatory arthritis, often of the big toe
- Dropped arches
- Metatarsalgia- pain in the fore foot caused by inflammation due to bursitis or a neuroma.
Treatment and Management:
The joints of the feet and ankles are very strong and so treatment techniques will likely include osteopathic mobilisation and sometimes manipulation to help increase mobility.
Soft and deep tissue techniques will be used to address muscle strains and imbalances in the calves, shin and feet muscles.
Muscle contraction and relaxation techniques may be used to over-ride muscle strains and spasms deep within muscle groups. Medical acupuncture and ultrasound may also be used to reduce swelling and improve your healing rate.
Specific strengthening and stretching exercises may also be given to address above-mentioned imbalances in tightness and weakness. Balance related exercises may be required to rehab the joint back to proper function and stability if ligament injury is identified.
For traumatic injuries causing lateral ankle pain, it may be sensible to rule out serious damage like fracture or dislocation. A rolled or sprained ankle can cause significant pain, bruising and swelling, even if it is only the ligaments that are damaged, so a trip to A & E for x-ray is sensible.
For soft tissue injuries (muscles, tendons, and ligaments), your osteopath will be able to carry out a series of tests to determine the tissue responsible for your discomfort. Occasionally we may ask you to see your GP to get a referral for MRI scan.
Muscular Aches and Pains
Muscular strains, tears, pain, or injuries can range widely in severity and occur due to a variety of reasons. Some people experience muscular aches and pains as a symptom of an underlying joint problem.
Muscular tears or injury are a common cause of sports injuries, especially in the lower legs.
When muscles become fatigued or tired, have excess load placed onto them, or are asked to lengthen further than usual, this can cause excess stress and injury to the muscle.
Muscles can also strain when doing simple tasks such as lifting things around the house, such as furniture, shopping, or your children.
People also often experience muscular pain or ache in the upper back and shoulders, due to long periods sitting or overuse at work.
The tendon is the tough part of muscle that connects the muscle belly to bones. They are strong and able to withstand a lot of tensile force. However, these tendons can become injured either through acute injury or consistent repetitive strain. This can then lead to pain caused by a tendinopathy. Common examples of tendinopathies are golfers/tennis elbow, or patellar tendon tendinopathy.
Causes and symptoms of muscle pain and tendinopathies can include: pain that can be incredibly sharp during acute injury, or a low grade dull ache with more consistent pain, redness or heat, swelling, bruising can occur with more serious muscular tear, tenderness on touch or stretching of the muscle, and local pain in the tendon or muscle belly, depending on which area is affected.
Treatment: Your osteopath will provide treatment for muscle aches and tendinopathies, using soft tissue and sports massage, combined with osteopathic techniques.
As mentioned above, it is important to find out which muscle or muscle groups are injured, as well as whether there is involvement of the ligaments as well. It is then important to determine whether it is the muscle belly, or the muscle tendon that is affected, as management of each is slightly different.
Hands on treatment working through the soft tissues will be carried out, using a variety of techniques utilising different amounts of pressure, rhythm, and speed depending on each presentation. The purpose of this is to increase blood flow to the muscle, stretch or elongate the muscle (safely), and promote tissue healing.
Management is case dependant on the injury. It will usually involve graded exercise rehabilitation, with the purpose of slowly increasing the load a muscle injury is able to handle, while maintaining or increasing the flexibility. Due to their rich blood supply, muscular injuries usually heal faster than other types of injuries, however this is not always the case with tendinopathies. This will be discussed with you at your consultation.
Muscle spasms and pains are the spontaneous contractions within muscle tissue - often the body's method of protecting damaged structures, or as a means to protect itself from injury. Muscle spasms in the back can be caused by a muscle strain, a sprained muscle, or an underlying condition.
Causes of Muscular Spasms Muscular spasm may caused by either direct damage to muscle (e.g. pulling a hamstring whilst running) or as a protective contracture, which is often nature’s way of creating a splint to protect an underlying fault.
• Spasms may affect many different types of muscles in the body, leading to many different symptoms and presentations.
• Spasms of skeletal muscles are most common and are commonly treated by osteopaths. They are often due to dehydration and electrolyte abnormalities. The spasm may occur abruptly, can be painful, and is usually short-lived. It may be relieved by gently stretching the muscle.
• If muscle spasms are especially painful, if they do not resolve or if they reoccur, medical care should be accessed to look for possible underlying causes.
Treatment: In treating back muscle spasms, it is very important to diagnose the underlying problem and the treatment should be sensibly directed at this underlying cause. Unless the underlying problem is evaluated, discovered, and treated, the back muscle spasms will tend to reoccur. The osteopath will discuss your condition, explain the problem including the treatment and plan to help improve and resolve it.
Exercises and advice on lifestyle and posture are often given when indicated.
Your GP may be able to prescribe medication to relieve muscle spasm.
This section is recommended for any individual who is taking part in high intensity sport. Your osteopath’s approach is based on principles of movement, principles of real life, and principles of the sport at hand. Osteopaths are trained to understand the biomechanics of human movement and therefore our therapy targets the specific areas of need that will assist in the most authentic, real-life, and quickest recovery of players back to their sport.
From tennis elbow to Achilles tendon damage, your osteopath can diagnose, treat and rehabilitate a wide array of common sports injuries. Remember- osteopathy isn't just for backs- our therapists are trained to a high standard for all musculo-skeletal complaints. Treatment is tailored to every individual to ensure that the fastest resolution to your problem is met.
There are many types of sporting injuries that can be treated by your osteopath.
Shoulder injuries- such as rotator cuff tears and tendonitis- common in swimmers
Tennis elbow- inflammation of the extensor muscle tendons in the forearm
Golfers elbow- inflammation of the flexor muscle tendons in the forearm
Repetitive strain injury (RSI)- inflamed tendons from overuse
Strained wrist- commonly from a fall on an outstretched hand
Spinal pain- often from lifting or landing injuries
Rotated Pelvis (Sacro-iliac joint dysfunction)- common in torsional sports such as golf or racquet sports
Hip pain- from falls, contact injuries or excessive range of movement
Knee pain- ligament injuries are common especially in contact sports, but also degenerative pain in weight-bearing sports like running
Ankle joint problems- usually instability injuries causing ligaments to be strained or torn
Achilles Tendonitis and heel pain
Impact injuries- frequently from contact sports and martial arts.
Treatment: In terms of treatment- we usually combine muscular stretches and massage, medical acupuncture, joint mobilisation and manipulation techniques to tailor a specific regime to your needs, depending on the type of injury.
Your osteopath also may use electro-therapy such as ultra-sound to speed up your recovery.
In most cases we suggest exercises to be carried out between appointments and may work with other therapies to ensure the fastest recovery (e.g. sports massage, physiotherapy, podiatry and acupuncture).
Sports nutrition is fast becoming another area where we are happy to provide advice.
Sports injuries their prevention and rehabilitation
Your osteopath can work with the trainers and coaches to design bespoke rehabilitation programmes based on the science of movement, the anatomy of the human body, and the key areas that need to be kept healthy to prevent injury.
When rehabilitation has been successfully completed, an athlete can feel strong enough to return to sport and the coaches can drive them to ultimate performance.
Programmes will focus on strength & conditioning, dynamic flexibility, and neuromuscular stability in the ranges of joint movement required for your sport. Real rehabilitation looks a lot like your regular exercise.
No magic tricks, quick fixes, or wishful thinking. Just progressive movement and recovery.
It’s about decreasing fear, anxiety, and sensitivity to pain, whilst building strength, tolerance to load, and confidence in your body. Your osteopath will use graded exercise progressions, to ensure that each stage of your rehabilitation is optimal for the current stage of injury, helping you return to sport more quickly and prevent re-injury.
Injuries preventing you from playing and participating in the sports you love can be incredibly frustrating. Your osteopath can offer treatment and rehabilitation of sports injuries for all athletes so if you’d like to start your journey to recovery from injury and return to your sport, simply book an appointment. Your osteopath is here to help.
PREOPERATIVE AND POSTOPERATIVE REHABILITATION (Prehab and Rehab)
Having an operation is not an ideal situation and we would all love to avoid this last resort. However, due to injuries or wear and tear in the body, an operation can become a much needed intervention. The question is, how much will you be able to do post operation?
This is where your osteopath can design you post-operative rehabilitation programme to help you reach your goal by:
- Creating aims and goals with the patient,
- Analysing what is realistic and achievable using our professional understanding,
- Liaising with the orthopaedic consultant where appropriate to formulate a concrete plan.
Once these are complete your osteopath will use an individualised, functional approach using a variety of hands-on techniques, corrective exercises based on your biomechanics, and by creating an empowering atmosphere guiding you through each step of the process.
In the lead up to undergoing surgery, it is important to make sure your body is in the optimal state for recovery. There will often be a relative period of inactivity.
It is therefore important to build muscular strength around the area before undergoing surgery, to provide the best possible outcomes afterwards.
This preoperative programme will involve undergoing movement assessment and graded exercise prescription, to improve neuromuscular control and dynamic flexibility, with the intention of increasing tissue resilience and improving joint mechanics.
It may also simply involve going through some basic, low resistance movements such as supported squats, or hip movements.
This will depend entirely on your specific injury, the procedure you are awaiting to undergo, and current fitness levels.
Your osteopath will take a detailed case history to understand clearly the nature of your injury and what procedures you have been through. This involves looking at your reports and other investigations you may have had. Your osteopath may need communicate with your consultant.
Then a clear, thorough assessment which taking into account how your body moves from a general perspective will be carried out. A more detailed specific analysis to determine the areas that need attention will also be required.
After this your osteopath will explain clearly what has been found and how best to create a programme that will enable you to reach your aim or goals, returning you to your normal activities.
This provides a realistic and achievable outlook for your recovery.
The human body will not function in synchrony unless we look at the body as a whole. This concept is one of the principles of osteopathy.
The science comes in when trying to understand how to create easy progressive steps towards your goals.
Your osteopaths experience in rehabilitation, functional movement assessment, and principles of osteopathy allows a bespoke rehab programme, that takes into account the nature of your injury, the anatomy, the biomechanics, and other factors that may prevent healing, to be created.
This could include your nutrition, sleep, or psychological well-being.
Many women experience mechanical pregnancy pains at some stage during the course of their pregnancy.
Your osteopath has a great deal of experience in the treatment of these types of complaints and offer fast, effective solutions to alleviate common symptoms.
Back pain in pregnancy is one of the most common symptoms that pregnant women complain of. Sciatica treatment (for a trapped nerve in the leg), relief for Sacro-iliac joint pain and help with Symphysis Pubis Dysfunction, or PSD (pelvic joint pain at the front), are also commonly treated. Fluid retention causing hand numbness (carpal tunnel syndrome) is another common “side-effect” of pregnancy which can be eased using osteopathy.
Pelvic Pain in Pregnancy
Some women develop pelvic pain in pregnancy. This is sometimes called pregnancy-related pelvic girdle pain (PPGP) or symphysis pubis dysfunction (SPD).
Symptoms of PPGP
PPGP is a collection of uncomfortable symptoms caused by a misalignment or stiffness of your pelvic joints at either the back or front of your pelvis. PPGP is not harmful to your baby, but it can cause severe pain around your pelvic area and make it difficult for you to get around. Different women have different symptoms, and PPGP is worse for some women than others.
Symptoms can include:
• pain over the pubic bone at the front in the centre
• pain across one or both sides of your lower back
• pain in the area between your vagina and anus (perineum)
Pain can also radiate to your thighs, and some women feel or hear a clicking or grinding in the pelvic area. The pain can be most noticeable when you are:
• going upstairs
• standing on one leg (for example, when you’re getting dressed or going upstairs)
• turning over in bed.
It can also be difficult to move your legs apart – for example, when you get out of a car.
Occasionally, the symptoms even clear up completely. Most women with PPGP can have a normal vaginal birth.
SPD affects up to one in five pregnant women to some degree. It’s not known exactly why pelvic pain affects some women, but it’s thought to be linked to a number of issues, including previous damage to the pelvis, pelvic joints moving unevenly, and the weight or position of the baby.
Factors that may make a woman more likely to develop PPGP include:
• a history of lower back or pelvic girdle pain
• previous injury to the pelvis – for example, from a fall or accident
• having PPGP in a previous pregnancy
• a hard physical job
Treatment: If you get the right advice and treatment early on, pelvic pain can usually be managed and the symptoms minimised. Treatment by an Osteopath usually involves moving the affected joint, which helps it work normally again.
If you notice pain around your pelvic area, tell your midwife, GP or obstetrician. Ask a member of your maternity team for a referral to an Osteopath or manual physiotherapist who is experienced in treating pelvic joint problems. These problems tend not to get completely better until the baby is born, but treatment from an experienced practitioner can significantly improve the symptoms during pregnancy.
Osteopathy aims to relieve or ease pain, improve muscle function and improve your pelvic joint position and stability. This may include:
• manual therapy to make sure the joints of your pelvis, hip and spine move normally
• exercises to strengthen your pelvic floor, stomach, back and hip muscles
• exercises in water
• advice and suggestions, including positions for labour and birth, looking after your baby and positions for sex
• pain relief, such as TENS
• equipment, if necessary, such as crutches or pelvic support belts.
• Be as active as possible within your pain limits, and avoid activities that make the pain worse.
• Rest when you can.
• Get help with household chores from your partner, family and friends.
• Wear flat, supportive shoes.
• Sit down to get dressed – for example, don’t stand on one leg when putting on jeans.
• Keep your knees together when getting in and out of the car – a plastic bag on the seat can help you swivel.
• Sleep in a comfortable position – for example, on your side with a pillow between your legs.
• Try different ways of turning over in bed – for example, turning over with your knees together and squeezing your buttocks.
• Take the stairs one at a time, or go upstairs backwards or on your bottom.
• If you’re using crutches, have a small backpack to carry things in.
• If you want to have sex, consider different positions, such as kneeling on all fours.
• standing on one leg
• bending and twisting to lift, or carrying a baby on one hip
• crossing your legs
• sitting on the floor, or sitting twisted
• sitting or standing for long periods
• lifting heavy weights, such as shopping bags, wet washing or a toddler
• pushing heavy objects, such as a supermarket trolley
• carrying anything in only one hand (try using a small backpack)
Back pain in pregnancy
Hormonal changes during pregnancy cause an increase in the level of the hormone Relaxin which has an effect on softening the ligaments (structures which hold joints together). During pregnancy, the ligaments in your body naturally become softer and stretch to prepare you for labour. This can put a strain on the joints of your lower back and pelvis, which can cause backache.
Avoiding backache in pregnancy
There are several things you can do to help prevent backache from happening, and to help you cope with an aching back if it does occur.
The tips listed here can help you to protect your back – try to remember them every day:
• avoid lifting heavy objects
• bend your knees and keep your back straight when lifting or picking up something from the floor
• move your feet when turning round to avoid twisting your spine
• wear flat shoes as these allow your weight to be evenly distributed
• work at a surface high enough to prevent you stooping
• try to balance the weight between two bags when carrying shopping
• sit with your back straight and well supported
• make sure you get enough rest, particularly later in pregnancy
A firm mattress can also help to prevent and relieve backache. If your mattress is too soft, put a piece of hardboard under it to make it firmer. Massage can also help.
Exercises can ease backache in pregnancy
The gentle exercise below helps to strengthen stomach (abdominal) muscles and this can ease backache in pregnancy:
• start in a box position (on all fours) with knees under hips, hands under shoulders, with fingers facing forwards and abdominals lifted to keep your back straight
• pull in your stomach muscles and raise your back up towards the ceiling, curling your trunk and allowing your head to relax gently forward – don't let your elbows lock
• hold for a few seconds then slowly return to the box position
• take care not to hollow your back – it should always return to a straight, neutral position
• do this slowly and rhythmically 10 times, making your muscles work hard and moving your back carefully
• only move your back as far as you can comfortably
The National Institute for Health and Clinical Excellence (NICE) advises that exercising in water, massage therapy, and group or individual back care classes might help to ease back pain in pregnancy.Some local swimming pools provide aquanatal classes (gentle exercise classes in water, especially for pregnant women) with qualified instructors. Ask at your local leisure centre. Being in water will support your increasing weight.
For a more personalised exercise regime that is individually suited to your symptoms, ask your Osteopath.
Although it may be difficult to avoid mechanical pain during pregnancy entirely, we will help to minimise your discomfort and are available to give you a helping hand throughout these important 40 weeks. Contact us today to arrange a consultation.
Cranial Osteopathy (Craniosacral therapy) is a very gentle specialty within Osteopathy, which is particularly useful for the treatment of children.
Cranial Osteopathy can be helpful if a child has had a difficult birth or for those “unsettled” babies and children. Cranial Osteopathy works with the body’s involuntary mechanisms, helping to restore a calming balance to natural biorhythms by means of gentle massage of the child’s skull.
The information below is taken from the Sutherland Society website and describes in more detail the benefits of cranial osteopathy.
What is Cranial Osteopathy?
Cranial osteopathy is a refined and subtle type of osteopathic treatment that encourages the release of stresses and tensions throughout the body, including the head.
It is a gentle yet extremely effective approach and may be used in a wide range of conditions for people of all ages, from birth to old age.
Osteopaths may have different specialties including sports injuries, paediatrics, and visceral osteopathy (treating the internal organs of the body). Cranial osteopathy embraces all of these.
lnvoluntary Motion- The Cranial Rhythm
Cranial osteopaths are trained to feel a very subtle, rhythmical shape change that is present in all body tissues. This is called Involuntary Motion or the Cranial Rhythm. The movement is of very small amplitude, therefore it takes practitioners with a very finely developed sense of touch to feel it. This rhythm was first described in the early 1900's by Dr. William G. Sutherland and its existence was confirmed in a series of laboratory tests in the 1960's and '70's.
Tension in the body disrupts the cranial rhythm. Practitioners compare what your rhythm is doing to what they consider ideal. This shows them what stresses and strains your body is under at present, and what tensions it may be carrying as a result of its past history. It also gives them an insight into the overall condition of your body, for example if it is healthy, or stressed and tired.
Accumulation of stress and strain in the body
When we experience physical or emotional stresses our body tissues tend to tighten up. The body may have been able to adapt to these effects at the time, but a lasting strain often remains. Any tensions which remain held in the body can restrict its free movement. Gradually the body may find it more and more difficult to cope with accumulated stresses and symptoms may develop.
What can cranial osteopaths treat?
While it can be highly effective at relieving symptoms cranial osteopathy aims to treat the whole person not just the condition, so a very wide range of situations may benefit from treatment.
In babies and children many of the usual problems of infancy and childhood may be helped.
Cranial Osteopathy for Babies and Children
It is a common belief that babies and children should have no stresses or strains in their bodies, because they are 'so young'. The reality is very different. Birth is one of the most stressful events of our lives. The baby is subjected to enormous forces, as the uterus pushes to expel the baby against the natural resistance of the birth canal. The baby has to turn and twist as it squeezes through the bony pelvis, on its short but highly stimulating and potentially stressful journey.
The baby's head has the remarkable ability to absorb these stresses. In order to reduce the size of the head, the soft bones overlap, bend and warp as the baby descends. The baby's chin is normally well tucked down towards its chest to reduce the presenting diameter of the head.
Many babies are born with odd shaped heads as a result. In the first few days, the head can usually be seen to gradually lose the extreme moulded shape, as the baby suckles, cries and yawns. However, this unmoulding process is often incomplete, especially if the birth has been difficult or was assisted with forceps or ventouse. As a result, the baby may have to live with some very uncomfortable stresses within its head and body.
Some babies cope extremely well with even quite severe retained moulding and compression, and are contented and happy. For others it is a different story. Osteopaths have some observations about how these retained compressions and stresses might affect the baby.
Compression in the bones and linings of the skull
The baby may be uncomfortable, with a constant feeling of pressure in the structures of the head. This may be made worse by the extra pressure on the head when lying down. There is more about compressions of the bones of the skull further down this page.
Pressure on nerves
Osteopaths consider that the nerves to the lips, cheeks and tongue can be affected by birth compressions. These nerves exit the base of the skull, and in the baby this area is not as well protected as it is in the adult. Baby needs these nerves and muscles to be working well in order to latch on and suckle comfortably and efficiently.
Tension in muscles and soft tissues
The tube to the stomach, the oesophagus, passes through a sheet of muscle under the ribs called the diaphragm. Stress from a difficult or fast birth can cause tension in the diaphragm, trapping wind. If the diaphragm is pulled out of shape around the oesophagus, it can compromise the ability of the stomach to retain its contents. Any strain through the umbilical cord, for instance if the cord was around the baby's neck, can add to strains in the abdomen.
General level of tension
Stress in pregnancy and during birth contribute to the general level of tension of the baby, and can keep the baby's nervous system in a persistently alert state. This can occur with either a difficult, or a very quick birth- the baby may find it difficult to relax fully and may have difficulty sleeping.
There is a theory that if the baby is in a persistently alert state, it's digestion can work too quickly. Milk may exit the stomach before it has had a chance to digest, and the partially digested milk enters the intestine where it may ferment and produce wind which can be uncomfortable for the baby.
In older children there is now much medical evidence that stress during pregnancy and difficult birth can lead to problems later on.
More about compressions of the bones of the skull
Physical compressions may also affect function. Osteopaths consider that the structure of the head and body has a profound affect on their functioning. Unresolved birth compressions around the base of the skull and the ears can compromise drainage of the Eustachian (Auditory) Tube and leave the ears more vulnerable to recurrent infections and glue ear.
Further forwards on the same bone that the ear sits in, one of the nerves to the eye muscles passes under a ligament. This area is sensitive to birth compressions, and if the function of this nerve is compromised, the eye on that side may have difficulty turning outwards, the situation known as strabismus or squint. Often strabismus resolves itself, or there can be other causes. Osteopaths will always ensure that your child is referred to their doctor if necessary.
The bones of the face and jaws can also be subject to birth compressions. The osteopathic view is that the bones of the face and jaws need to be free of birth compressions in order to grow to their fullest dimensions, to allow space for the teeth and avoid overcrowding or occlusion problems. If compressions affect the full development of the nasal passages, then the child may tend to breathe through the mouth. Orthodontists recognise that mouth breathing leads to the tongue not supporting the upper arch of the teeth, and the teeth may grow unevenly.
These are just a few examples of how osteopaths see the structure of the head and body affecting function.
Cranial osteopathic treatment
Osteopathic treatment using the cranial approach is gentle, safe and effective for babies and children. Very specific, skilled, light pressure is applied where necessary to assist the natural ability of the body to release stresses and tensions.
Could there be any adverse reactions?
Reactions to treatment are variable; often the baby or child is very relaxed afterwards and sleeps well. Others have a burst of energy after treatment, usually followed by a good nights sleep.
Occasionally children are unsettled after treatment. This is a temporary situation, and usually clears within 24-48 hours.
Osteopaths will always ensure that patients and their babies and children seek appropriate medical advice and treatment alongside any osteopathic treatment, and will refer patients back to their GP if a problem is not suitable for osteopathic treatment.