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Pain Relief

Physician Heal Thyself – how I got my knee pain fixed!

By Pain Relief, Sports

Physician Heal Thyself

It’s an old saying, “physician heal thyself”.  Not for the first time in my career did I find myself wondering how to fix one of my own pains!

Start of hiking route near Black Rock, Cheddar GorgeI have always loved the outdoors and in particular hill walking. For me it is much more than walking, it is my therapy, my health, my social life and above all it defines my relationship with my partner. So it came as a shock to me in summer of this year when left knee became swollen and sore, limiting my ability to walk even 2 hours. By contrast I was walking 5 – 7 hours over hills, mountains and Lakelands for many years. Now being in my mid- 50s, I began to feel the curtain of early arthritis falling upon me.

I have always known my left hip was a bit stiff, but a year before when I took my young teenage nephew wild camping in Wales, I noticed an achy pain on the outside of my left hip during a long walk carrying our rucksacks. So when this knee pain came on I assumed that my stiff hip was making my knee work harder.

As a practicing osteopath having treated other patients with a similar condition I thought some simple stretches  to my hip would be the answer. It worked to a point, but I never managed to shake off the hip problem. With an expedition looming to Chiang Mai in Thailand in 5 months I was beginning to get a little anxious.

It’s a curious thing healing oneself, it’s so hard to see the wood from the trees. It is exactly for this reason that even a medical doctor is required to nominate someone to be their doctor, ie you cant be your own doctor.

It was over a lunchtime meeting when my senior associates Hugo Firth came to ask me a question on managing a patient. At our clinic we collaborate over clinical issues to try and provide the best solutions for our patients and we win too as it helps develop us as a team.

At the end of the chat I asked Hugo if he could shed any light on my knee. It turned out that my left hamstring was a little shorter than it should be. That was the connection between my hip and my knee pain (amongst other findings). Hugo gave me some magical exercises.  In no time he had me doing hip, calf and hamstring exercises.

As a fully qualified osteopath Hugo is also certified by the highly acclaimed Gray Institute of Functional Exercise Therapy. As such he brings a unique contribution to the osteopathic management of sports injuries for our patients.

boggy ground

A typical section of the walk

This weekend my partner and I took a short 3½ hour walk at Cheddar Gorge. We try and book a weekend away once every quarter, ie with the change of each season to help keep us recharged. I recommend this to many of my patients too, as it can give you that lift just when you need it!

I started the walk temperately and after a short while I noticed my old left hip pain came back again. But as I opened my stride and stretched out my hip and hamstring, to my sheer adulation and joy, I managed to walk off the pain and completed our entire walk. As if proof of the pudding were required, that evening and the next day I had no symptoms whatsoever in my knee or hip.

The magic of Hugo’s dynamic exercises is awesome. They are not the “usual” stretches, they are actually exercises working specific muscle groups with a clinical perspective.  As an osteopath Hugo correctly identified the incriminating dynamics of my pain pattern and gave me the correct work-outs my knee and hip needed to keep me going.

Needless to say I have adopted this learning into my own patient care. Learning from my associates is also great for me and something I enjoy.  We have a wonderful talent-pool here at our clinic with lovely clinical staff. By sharing with each other not only do our patients benefit, but through our collaboration we can help provide better results than a single mind could by itself. We cover everything from new-born babies, children treatment, stomach problems, respiratory difficulties and of course back pain.

If you would like a to see Hugo about a knee or hip pain, or indeed any activity related symptoms, please use this link HERE or fill in our online questionnaire for a personal reply.

senior osteopath, Wimbledon

Vispi Jamooji DO PGCert SPOP
Osteopath (1986)
Paediatric & Cranial Osteopath

20th November 2019
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What is Osteopathy?

By Pain Relief

Osteopathy Treatment

What is Osteopathy ?

I would simply say Osteopathy is a medical form of massage best known for treating back pain and neck pain. But it is much more powerful, treating other health complaints such as stomach problems, breathing problems, children’s complaints, stress management and more.

How does Osteopathy achieve this?

Osteopathy uses the muscle-body-brain relationship. Through the action of releasing tight muscles, stiff joints, un-trapping nerves and bringing fresh blood to an area, health can be boosted.

Osteopath’s are highly specialised at boosting health by exploiting this relationship. By contrast traditional medicine largely exploits the chemical pathway to health. Using drugs they can also achieve the release of muscles, joints, trapped nerves and also increase blood flow. However comparing like for like osteopathy can provide a drug-free way of getting better free of toxic side effects.

Nevertheless the massage-treatment is only the headline work of an osteopath. Importantly and much less well known, is the educational work that goes into making osteopathic care successful. This allows the patient to take control of their health, getting better faster, and staying better. For example treatment may progress a person 3 steps forward but if you don’t know how to care for yourself, you may take 3 steps backward again. This is a common reason for failing to heal or for incomplete healing.
In this way osteopathy is as much about education and patient awareness, as it is about the headline massage and manipulation treatment people are more familiar with.

Low back pain explained

More Than Pain Relief

By keeping the muscles and joints doing what they were designed to do – move – osteopathy keeps your body fluid, fresh and active. Osteopathy can help with organs of the stomach (visceral osteopathy), relaxation of the mind & stress management (cranial osteopathy), management of new-born babies & children (paediatric osteopathy) and of course pain-relief.

Movement is king

Osteopathy is Movement. Movement is King

The unique contribution of osteopathy to healthcare is restoring health thought movement.
For example if your joints “rust up” you are more likely to injure as your body is less supple. If your neck muscles are tight it can obfuscate the blood flow to the brain creating “brain fog”, if your diaphragm is tight you may experience difficulty taking a proper breath or affect your digestion. If the base of your skull does not move freely it may create face, jaw, sinus or ear pain.

In all these cases and many more besides, movement is needed for health. Osteopathy provides this unique cross-over between movement and “healthy” health.
Perhaps that’s why osteopathy is so popular in the UK and widely used by so many people seeking a different type of help, providing a reliable alternative for so many health conditions.

Vispi Jamooji DO PGCert SPOP
Osteopath (1986)

Any questions please fill in our online form here

14th November 2019
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A Different Approach to Preventing Back Pain

By Exercise, Pain Relief

A Different Approach to Preventing Back Pain

If you suffer from recurring back pain and your current rehab exercises that work on strengthening your core don’t seem to stop your back pain from recurring then perhaps it is time to take a different approach.

For at least the last 30 years there has been a focus on advising people to strengthen their core stability muscles that in turn will prevent back pain. However, the research to support this is thin at best. Much of the research has been carried out on small non representative samples1 . When the samples are representative then whilst some short term benefits can be found no long term benefits (over 6 months) can be seen2 in back pain prevention. Alternatively, it was found that core stability rehab is no more effective than general exercise3.

What’s the thinking behind Core stability exercises?

In essence the theory is by activating your core stability muscles such Transverse Obliques, Rectus Abdominus, pelvic floor, internal and External Obliques, and diaphragm you can help support the lumbar spine and so help manage its work load.

However, if the research is right and there is a lack of effectiveness then perhaps we need to ask the question ‘Why can’t our backs cope with the work load in the first place?’

An Alternative approach

The area of your spine that is in pain is a result of it trying and ultimately failing to cope with extra work load because other parts of the spine or body are not moving as well as they should.

This can cause, muscle strains, ligament strains , joint inflammation and disc herniations and ultimately osteo-arthritis.

Why does Overwork occur?

Low back pain explainedThe body has this amazing ability to adapt and deal with reduced function in one part of the body to maintain our overall function. The spine is a key part of this.

24 interlinking segments that act liked a coiled spring. If a section of the coil stops moving then the sections above and below move more to ensure our bodies can achieve the movement we require. It’s this extra movement of muscles and joints that over time can lead to muscle fatigue and joint inflammation. These are two main symptoms of lower mechanical back pain.

Address the causes not the symptoms

With our more sedentary lifestyle many patients with lower back pain often have common factors such as reduced mobility in the upper back and shoulders and reduced mobility in the pelvis and hips.

Coincidentally these are the two main areas of our body that we keep static for long periods of time every day of the week whilst we are seated!

 

Our sedentary lifestyles reduce our mobility

Poor postureIt is this lack of movement in these two areas that can cause us lower back pain in the long term.

We sit at our desk, shoulders forward, fingers ready to type on our key boards, heads forward, upper back arched. Our hips flexed. Sometimes for hours at a time.

Our bodies take these inputs as a desired position and start to adapt accordingly. The body is always looking for efficiencies to reduce energy expenditure. So it reduces blood supply to muscles. Joints stop moving so nerves receive less innervation.

Muscles in our upper backs become fibrotic and joints become less mobile.

We do this day in day out for up to 8 hrs a day for months and even years! Then we go home and watch TV or use our laptops at home, or alternatively try and get the stress of our work out the system and go cycling and assume the exact same position. Or we go to the gym and contract the same muscles that were contracted at our desks (our pectorals and biceps and hip flexors)

Implications for our Lower back 

If the middle section of our spine can no longer rotate or bend forward as much as it used to do then the lower back (the lumbar spine) will have to move more to ensure that there is no reduction in functional ability and range of movement.

Likewise if we cannot rotate from the hip or our hips are flexed forwards because our hip flexors are permanently contracted from all the sitting down we do then our lower back muscles become more involved in simple daily activities such as walking and standing.

Our bodies make these adaptations without us being aware of them. Day in day out for months and years.

Then add in the role that the lower back was designed for and you can start to see why an upper back or hip that can’t move optimally can help increase the risk of fatigue, strain and ultimately, injury in the lower spine.

The Long Term solution

Change the inputs in your upper back

From a static 8 hrs. Stop every 30-45 mins and make your upper back and shoulders move. Your body will respond by increasing blood supply. Muscles will change to become more flexible. Joints and innervation inputs will increase.

Here is a simple exercise you can do at work whilst sitting down to start changing the inputs. Do it every 45-60 minutes that you are at your desk. Your colleagues might think you are mad at first but soon they will all start doing it! It really works.

 

Change the inputs to our hips and pelvis

We need to reduce the tightness in our hip flexors that builds up over time as we sit at our desk, cars, TV, dinner table and on our bikes . Here is a really effective exercise to do just that.

Do it daily am and pm 10-15x. Include it into any activity warm ups and warm downs too. Especially after cycling or running.

Next we need to improve the mobility and rotation of the hip as well as activating the gluteals and hamstrings.

This exercise combines hip flexion stretches with hip rotation.  Do it am and pm 10-15x for each exercise.  These exercises should all be pain free so if you experience pain after or during then just stop and consult your professional physical therapist.

To Conclude

If you have been doing your core stability exercises and you have had no recurrence of lower back pain, then please continue but consider if you are really addressing the cause. With our increasingly sedentary lifestyles we are placing increasing work load on our lower backs due to a lack of mobility above and below in our upper backs and hips. So if you are doing core stability exercises then add hip and upper back mobility exercises into the mix. If you are not doing any exercise then start to work on hip and upper back mobility with the above exercises. The exercises should always be pain free.

References

(1)Stuber KJ1, Bruno P, Sajko S, Hayden JA, Clin J Sport Med. 2014 Nov;24(6):448-56. doi: 10.1097/JSM.0000000000000081.Core stability exercises for low back pain in athletes: a systematic review of the literature.

(2) Xue-Qiang Wang,1 Jie-Jiao Zheng,2,* Zhuo-Wei Yu,2 et al. Public Library of Science. 2012; 7(12): e52082.Published online 2012 Dec 17. doi:  1371/journal.pone.0052082A Meta-Analysis of Core Stability Exercise versus General Exercise for Chronic Low Back Pain

(3)George SZ1, Childs JD, Teyhen DS, Wu SS, Wright AC, Dugan JL, Robinson ME. BMC Med.2011 Nov 29;9:128. doi: 10.1186/1741-7015-9-128.Brief psychosocial education, not core stabilization, reduced incidence of low back pain: results from the Prevention of Low Back Pain in the Military (POLM) cluster randomized trial.

 

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11th October 2019
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Science of Quick Healing

By Pain Relief

Science of Quick Healing

When you have a pain there is a strong instinct to rub it. True when you were a little child and you may have grazed your knee, a parent may have “rubbed it better”.  But it could it be the worst thing to do to an injury or pain! We explain the things you can do and why, to better help you manage your own recovery.

Managing inflammation vs muscle Spasm

What You Need To Know First. The body responds to almost all damage in the same way – inflammation.  This means the the spine and it’s tissues, produce fluid to try and bathe the area, accompanied with a muscle spasm for protection. The unique problem with back and spine pain is that the accompanying muscle spasm can grow larger and larger if we don’t take the right type of rest as it tries to support the damaged section of the spine. This muscular compensation itself can become a source of further pain. In real-life it’s actually quite difficult to tell the difference between muscle spam & inflammation.  This is important as each needs to be treated quite differently.

The principle is usually simple, cool inflammed tissues and *gently massage muscle spasms (see end of article). But knowing which is which as mentioned before, is not easy to discern.

Inflammation. Perhaps the best way to know which is which is to ask a friend to gently examine the injured area. Inflamed tissues are typically swollen and hotter than surrounding tissues, and almost always acutely painful to touch. It usually feels like a “bouncy castle”. Press lightly and repeat several times; compare with the other side.

Back pain TreatmentMuscle spasms can a bit tricky. A clever way to work out if it is a spam is to try bending sideways to the opposite side you think the spams is on. If the spasm exists, bending to the opposite side will be painful or reduced. For example if you have a spam on the left low back, it will be harder to side-bend to the right.   Note: however certain cases where there is both inflammation and spam on the same side, then bending to the same side can be painful. If you can’t work it out, you may need professional help.

Once you know where inflammtion and is spasm is, you need to treat them differently. You can apply a cold pack to the inflammed tissue and massage or heat to the muscle spam. Generally both of these should be applied no more than 10 – 15 mins at a time, though it can be repeated several times a day, say no more than to 6 -10 times in a day – see next paragraph

Managing Hot & Cold

Cold is a great anti-inflammatory, it helps to reduce the swelling which causes pain 😊. But cold can make muscles stiffen & tighten up too ☹. Heat is a great muscle relaxant, reducing stiff, tight painful muscle spams 😊, but unfortunately has the effect of increasing inflammation ☹. That’s why we oppose people using a hot water bottle on the injury (which can increase inflammation) and then taking Neurofen – to take the inflammation away! The one works against the other and you get nowhere fast.

Managing Movement vs Rest

It’s difficult to know when to rest or move or indeed how to rest or what sort of movements to do! Let’s clarify this a bit:

Rest – the point is to eliminate strain on an injury whilst it’s trying to heal.
Gravity works against healing.  Rest is paramount, but rest does not mean sitting! When you are not lying down it means you are “up”. That means your body will be fighting gravity whether you are sitting, driving, shopping, walking, using a PC etc. This puts extra work on the muscles which are already compensating to protect the injury and then those muscles have to fight against gravity to hold you up. It’s a big ask on the body.

You can look at this another way too.  A man visits his GP and asks for antibiotics for his chest infection. As he leaves he flips a cigarette out of his top pocket and starts to smoke it. Obviously this can slow his recovery or at worst prevent him healing. To an osteopath gravity is like the cigarette – it works against healing. Try and avoid things like sitting, standing etc.

Movement – movement helps to drain inflammation and, at the right time, speeds up healing. The question is how much but the principle is actually simple. If after being on your feet say 20 minutes you notice symptoms, next time you will try and be on your feet only 15 minutes. It’s like a savings account.

 

Movement is King:  walking keeps the spine safe and the muscles strong.  In the later stages of recovery walks in nature is particularly helpful as the walking posture changes with each foot step.

A Special Word About Sitting

dont suffer back pain any moreSitting has never been proven to cause back pain. However when you do have back pain it is a high risk factor against healing. Perhaps that’s why people don’t always recognise sitting as an incumbency to healing, because they were doing it previously without harm and now need a paradigm shift to refrain from sitting. It’s a hard bridge to cross for many patients, but if you can get your head around that healing can be as fast and full as possible.

Managing Pain Relief Medicines

Paracetamol, codeine & Ibuprofen

Treatment without drugsThe confusion with paracetamol and ibuprofen is that they are often referred to as “pain killers”. In fact only paracetamol & codeine are actually pain killers, whilst ibuprofen is an anti-inflammatory.  The trick here is to work out if you are suffering more from inflammation or muscle spasm – which takes us back to “Inflammation vs Muscle Spasm” above. If it is predominantly muscle spasm paracetamol or codeine would be best; if inflammation then ibuprofen would be indicated. However if it is both, some medical practitioners prescribe both.

The main problem with taking any of these pills, is that we usually need some level of pain to help remind us to be ‘good’ – like lying down or avoiding sitting.  That’s one of the main reasons why people who self-prescribe eventually no longer respond to their medicines as they have over-ruled their body’s need for rest and made the injury worse.

Medical Information

Science of Pain

i) Nerves
One of the reasons why sitting is such an deceptive form of injury can be understood by studying the image below.

The image demonstrates the relative number of nerve fibres throughout the human body. Note that the back and spine have relatively few nerve fibres, compared say to the hands.  The reduced number of nerve endings in the back mean it is less likely we will be aware of injury when compared to stimuli on the hands for example. This means we will not always be aware if we are hurting ourselves through sitting, as and when our muscular posture starts to fail. Remember at the end of the day if it is ‘gravity’ vs ‘muscles’, gravity wins hands down and your spine will lose.

ii) Muscles
When the spine is trying to heal it asks certain muscles to support the injury. However these same muscles may also be needed for good posture, ie sitting or standing.

What you need to know
A single back muscle is made up of many groups of muscle fibres. These are known as a medically as a motor-units. We will call it a muscle-fibre-group in this example.

Example
For the sake of principle, lets say 3 muscle-fibre-groups make up a single back muscle. And also each muscle-fibre-group can only contract for 5 minutes, before it tires and needs a rest.  We can see by the end of 15 minutes all 3 muscle-fibre-groups would have all worked once. So if we ask the muscle to work further, ie  onward from 16 minutes, we have to recruit the first muscle-fibre-group again, even though it may not be fully rested / recovered.  Naturally by the time all these muscle-fibre-groups  have run a second innings they may start to give up, and naturally the posture fatigues, and eventually the weight of the body falls on to the spine, ligaments and discs causing it to hurt, weaken, or worse, deepen the injury.

It is exactly for this reason there is no “good” posture. The trick is not to stay in one position too long. Remember fidgets don’t get back pain because they are not in one position long enough to get it.

Keeping good posture is hard on our muscles at the best of time, let alone when we are injured. Asking the muscles to do 2 jobs at the same time (hold the injury together and keep your posture) is a big ask.

iii) Sleep
The genes for healing are most active during night sleep, in other words day-time healing is much much less powerful.  It stands to reason the more you sleep the higher the level of healing. Plus, if you go to bed earlier by one hour during injury, over 7 nights, you have the equivalent of an extra night’s sleep.  Further, if you are lying down one hour earlier each day, that’s one hour less the body has to battle against gravity.  Give it a try – if you are really suffering try going to bed early for one week and see the difference.

A good tip is to avoid lying on the painful side. You may prefer to use a small pillow between your legs if it is low backpain.

Final Word

We know its not always possible to do the right things all the time, but if you know how to keep in control you have a better say over your outcome. To some degree this means you can prioritise what’s important to you at a given point in time: healing or carrying on working. Being better informed helps you to know if you are doing right from wrong, and good from bad.

If you find this article helpful please share with a friend or if you would like to know how we may be able to help you please fill in this online form.

 

senior osteopath, Wimbledon

Vispi Jamooji Do PGCert SPOP
REGISTERED OSTEOPATH 1986

 

* massaging muscle spams can make the injury worse. Some muscle spams is there to protect the spine. Releasing too much of the spam can take the protection away making the spine vulnerable to potentially serious re-injury in the worst cases. If in doubt seek professional; advice, – call us on 02089462331

2nd October 2019
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Sciatica Made Simple

By Pain Relief

Sciatica Made Simple

sciatic pain can extend right down the legSciatic pain is commonly felt alongside lower back pain, it is described as pain in the leg (lower extremity). It occurs when there is irritation of the sciatic nerve, this is typically felt from the lower back down to the back of the thigh to the knee and sometimes further down into the ankle or foot.

Largest Nerve In The Body

The sciatic nerve is the largest and longest spinal nerve in the body, it extends from the lower back, running downward into the buttock or gluteal region, and into the back of the thigh and lower the leg (calf). Smaller individual nerves branch off from the sciatic nerve to reach muscles and skin and so can cause a variety of symptoms.

Commonly pain is only one side of the buttock or leg rarely felt in both sides, this is due to branching off into two sciatic nerves supplying each leg. If both legs have symptoms this may suggest either spinal nerve roots or cord is being compressed. The pain can vary from infrequent and irritation to constant and incapacitating.

Areas Of Discomfort

  • Low back (lumbar spine)
  • Hip and buttock (gluteal area)
  • back of the leg
  • Feet and toes

Symptoms

  • Pain: Stabling, Shooting, Burning or Dull Ache
  • Pins and needles (Tingling feeling)
  • Loss of sensation (Numb)
  • Muscles Weakness

Causes of Sciatica

Commonly the sciatic nerve is irritated in a result of a disc herniation that directly puts pressure on the nerve. Other causes such as local inflammation, trauma, and degeneration to the low back (lumbar spine) or disc. Pressure on the sciatic nerve from a muscle called piriformis (because of its pyramidal shape) can occur causing “Piriformis Syndrome”, producing symptoms similar to true sciatica.

Trapped nerves (radiculopathy) in the low back can produce diverse symptoms depending on which nerve is being trapped. The common ones are:

L4 Nerve Root (L3-L4): symptoms stemming from this level in the lower spine may include pain and/or numbness to the inside lower leg and foot; weakness to the foot

L5 Nerve Root (L4-L5): stemming from this level you may experience pain and/or numbness at the top of the foot, around big and second toe. Weakness may also be experienced potentially in the ankle.

S1 Nerve Root (L5-S1): pain and/or numbness to the outside the foot; weakness results in difficulty raising the heel off the ground or an inability to walk on tip-toes.

How to relief the pain?

  • A range of exercises/stretches can be used to relief the sciatic pain along with relief of lower back pain. Please watch our video on exercises to help relieve your lower back pain!
  • Pain may increase by prolonged sitting, standing up, twisting, lifting or straining; therefore reduce these movements to help relieve the pressure or irritation on the sciatic nerve.
  • Lying flat with a pillow to support your head and under your knees will help relieve the pressure on your back, using a cold compress on the affected side will help with any local inflammation that has occurred.

If your symptoms don’t improve it’s best to seek the professional advice, as the are also other medical conditions which may need to be looked at.

Osteopath, Wimbledon
Jennifer Beck, M.OST
Member of the General Osteopathic Council
Member of the Institute of Osteopaths

“I am available to help you today. Being gentle and working in tune with nature, it will be a relaxing way to heal“.
Jen.

Call anytime for an appointment of free telephone advice, 02089462331

New patients: book your first 60 minute appointment and treatment here

8th April 2018
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Reduce Running Injuries By Changing Your Running Posture

By Exercise, Pain Relief, Sports

Improve your running technique

These two pictures put side by side show how from childhood we have good hip extension. The knee of the back leg is almost a straight line with hips and abdomen and chest.  Haile Gebrselassie hasn’t lost that full hip extension either!

However for most of us that have desk based jobs our hip flexors – the ones that help us bend at the waist- become tighter and can keep us in a slightly flexed position. In turn this means that when we run we do not get full extension at the hip.

Why does this matter?

1) Increased risk of running injuries

If our hips remain slightly flexed through the gait cycle then the femur (thigh bone) is always slightly rotated inwards. This in turn can put extra strain on the IT band, the knee and the hip bursa which can leading to strain injuries in these areas.

We can also try to over compensate with a short back swing and with a longer stride. This takes up more energy too and can lead to greater strain on the knee and foot leading to Achilles tendonitis and patella femoral pain syndrome (pain behind the knee cap)

Alternatively, runners gain extra hip ‘extension’ by arching their lumbar spines and this in turn can lead to lumber spine pain.

 2) Reduced running efficiency

It also does not allow for most efficient running. When your hip reaches full extension you have stored maximum potential energy in the hip flexor muscles (psoas, iliacus and rectus femoris) which turns into Kinetic energy on the swing phase of the run as you bring your leg forward for the next step.

And so we can expend more energy in running with less hip extension.

What can you do ?

Running injuries tend to be multi-factoral but a lack of Hip flexion is often involved.

To help increase hip extension you need to work on lengthening your hip flexors (psoas, iliopsoas and Rectus Femoris) as well as activating and strengthening your Gluteal muscles.

And then consider how to incorporate this into your running posture. Look up as you run and run with a more upright stance. This will help with a greater degree of extension at the hip.

Here are two key exercises designed to help you do just that

Do them daily am and pm 10-15x each and work them into your warm ups and warm downs

Hip flexor stretch- a guaranteed antidote to sitting at your desk and shortened hip flexors

Hip extensor activation- Gluteal (buttock) strengthening

Hugo Firth BOst, BSc, MA
Osteopath and
Sports Rehab Specialist

Sports Osteopath Hugo Firth

Member of the General Osteopathic Council
Member of the Institute of Osteopaths
“My approach to healthcare is a balance between osteopathy and patient empowerment through effective therapeutic exercises. I recognise it’s not always possible to come in for a treatment, and many conditions can be helped with the right exercise if used early enough. After all prevention is much less painful than cure“.
I offer free advice via email, phone 0208962331 or by filling in this online form here
New Patients: 60 minute appointment  – book here please
8th April 2018
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Scans And Pills A Waste of Time For Back Pain

By Pain Relief

Pain killers and scans can harm you and wastes your money. Find out why.

Back & Neck Pain
Are Scans and Pills a Waste of Time?

As an osteopath, I found the following article a compelling read. It featured in The Independent and was entitled, “Opioids, injections and scans of ‘dubious benefit’ harming 540 million back pain sufferers worldwide” (21 March 2018). Curiously, this day is also my Persian New Year, the vernal equinox. I say curiously because I get the impression that the medical profession may be making a new start too, in managing spinal pain.

dont suffer back pain any more

Do I Need A Scan?

In private practice, one of the commonest questions I get asked as a practicing osteopath is, “Don’t I need a scan or an x-ray; or should I see my doctor?” In the case of the GP, I usually reply, “If you have a toothache, you go straight to the dentist, you don’t go to the doctor.”

In the same way, osteopaths, physiotherapists and chiropractors are medically recognised by the medical profession as primary healthcare practitioners in their own right. This is reflected in law by the respective acts of Parliament. This is because our clinical skills are recognised, and we are validated to work independently as specialists in this field. Day in and day out, that’s all we treat: back pain, neck pain, sciatica, trapped nerves, muscle spasms and so on. Of course, there is an overlap between our professions, which was actually the focus of The Independent article, which found that the reliance on traditional medical support is currently skewed against the patients’ best interests.

Back pain guidelines

Click here to see guidelines

If healing is slow, patients will request an investigation, such as a scan or an x-ray. This is quite understandable. However, research evidence has advised against this, unless certain criteria are met (for details, see later in the text). On the contrary, the government’s own guidelines, the NICE guidelines (November 2016), recommend that patient education and spinal manipulation, along with exercises. The guidelines also recommend combining physical treatment with psychological support, when necessary. Certain types of pain and some pains which are slow to heal may have psychological causes. This could be as straightforward as stress at work, home, relationship issues, emotional fatigue etc. Or, if it is more advanced, we may be looking at depression, for example, or other conditions that may require psychotherapy or cognitive behavioural therapy (CBT). In such cases, your osteopath is qualified to identify the need and refer you on.

Importantly, the evidence in the NICE guidelines that supports spinal injections / invasive procedures is poor. It specifically instructs doctors to avoid these procedures for pure low back pain, which also includes certain types of spinal surgery. In other words, it is encouraging us to consider a different approach to back pain, recurring pain and chronic pain. As a point of interest, modern medical books no longer refer to “back pain treatment”, as there has been a subtle change to re-word it as “back pain management”.

Increased Scans & Drug Use is Ineffective

Returning to The Independent news story, it reports that Professor Rachelle Buchbinder, a leading rheumatologist at Monash University, Australia, said: “The majority of cases of low back pain respond to simple physical and psychological therapies that keep people active and enable them to stay at work.” She added that: “Often, however, it is more aggressive treatments of dubious benefit that are promoted and reimbursed.” She was referring to the prescribing habits of the doctor, whether they be pharmacological, surgical or investigatory. She highlighted how the “Increased use of ineffective potentially unsafe treatments has wasted limited health-care resources and harmed patients,” such as opioid (painkiller) addiction and opioid mortality, which she cited as having escalated over the last 20 years in the USA. Her work has been published in The Lancet.

A New Way Needed

According to Professor Buchbinder, the idea of requiring a scan or prescription-grade medication is so ingrained in patient culture, they expect it and doctors largely acquiesce. Year after year, studies have supported Professor Buchbinder’s conclusions. In the light of such a waste of resources and actual harm, she is calling for a worldwide, top down, rethink – from governments and policy makers to healthcare practitioners – of this leading cause of pain and debility, which is occurring globally. In short, she is calling for a culture shift that will not only educate doctors and the public against the use of scans and strong drugs, but also urge them to consider physical therapy, rest, and most of all, education (something that osteopaths have been doing since the late-1880s, which is perhaps why osteopathy is so popular worldwide).

But Scans Do have Their Place

Returning to the scan requests, we do acknowledge that it is important to rule out the pathology (i.e. medical causes) of back pain, which would inherently require further investigation. Whilst pathology is thankfully very rare, the following list can help to put your mind at rest.

Serious red flags which require medical help include-

History of trauma enough to fracture a bone

Sudden weight loss

High fever

Loss of bowel / bladder function

Numbness around anus, scrotum or vaginal area

Weakness in any limb (ie arm or leg)

Foot drop

First onset of pain >55 years of age

Rest assured, every primary care physical therapist is qualified to detect and refer you in such cases. There are many simple neurological and orthopaedic tests that can be done in-house to help route you through to the best care. It is interesting to note that these consulting room tests are the same as the ones you would encounter when visiting a medical doctor.

What If Your Symptoms Are Getting Worse?

However, assuming that no pathology exists, where does this leave you, especially if your symptoms are unrelenting or getting worse? One of the most natural reasons for requesting a scan “is to see what is going on”. However, countless medical studies sadly show there is a very poor correlation between a patient’s symptoms and the findings seen on the scan. For example a systemic review of literature (this is a high level review, not just a single clinical trial) in 2015 concludes that: “Imaging findings of spine degeneration are present in high proportions of asymptomatic individuals, increasing with age. Many imaging-based degenerative features are likely part of normal aging and unassociated with pain.”

neck pain

Slipped disc not causing pain

I recall a case about 25 years ago, where I treated a middle-aged woman with spinal pain, who had been diagnosed with arthritis of the spine by her NHS team. In short, her pain was relieved by the treatment I gave her. But I mentioned to her that the arthritis in her spine would remain; the inference being that her back pain could not have arisen from the arthritis, as the arthritis would remain unchanged by the osteopathic treatment. In other words, the cause of her pain must have arisen from a different source (which thankfully is amenable to manipulative treatment). There are many such examples in which expensive scans, together with strong medication, are routinely given. This not only a waste of NHS resources, but also means there is a delay in the patient getting the right treatment, which only prolongs their suffering.

If You Do Need A Scan

In private practice, however, we do refer for scans, usually at the patient’s request. Such scans are costly. In fact, the cheapest I know of at the time of writing (March 2018) is about £300. So why do we do it? The main reason for me, is to enable the patient to see in black and white what their spine looks like, as there will always be a certain amount of degeneration in any scan (as mentioned above). It is my hope, rather than belief, this visual of their spine may help to prompt the patient to take better care of their spine. However, if nothing is seen on the scan, it shows the symptoms are not due to a medical pathology and are more likely to have arisen from soft-tissue overuse or psychological factors. In both these examples, it crucially helps to support patient education, as advocated by Professor Buchbinder, NICE, and the years of extensive research by other authors. Additionally, it helps to address the bio-psycho-social component of pain, i.e. how the patient’s body is being used throughout the day, physically and emotionally.

Before undertaking a scan, I carefully explain the reasons why it may be clinically unhelpful. Some patients concur and put the money towards something else in their lives, and some naturally don’t. Patient education is a slow process and we all learn at our own rate. I like to support patients on their healing journey in whatever way it is needed.

In conclusion, best practice dictates that we should help the patient to understand the root causes of the pain, and/or the factors which inhibit the healing cycle. This is what patient education is all about. Historically, this important pillar is often discounted by the patient, as their thoughts are focused on the expectation of a full 30 minutes of manipulation to effect a  “cure”. Manipulation needs to be allied with education, exercises, as well as psychological and social factors. Perhaps this is what makes the Living Centre Clinic such a successful clinic in delivering osteopathic treatment, in Wimbledon or anywhere else in the SW London area. Our osteopathic team provides a genuinely holistic treatment, bringing together the key aspects of health, lifestyle, emotion and injury correction.

Personal Comment

senior osteopath, Wimbledon

After all these years (since I graduated in 1986), it is heartening for me to see these tenets finally recognised and actively promoted by the medical profession. There is a move to change the way that society thinks about back pain, both nationally and globally. This is something I genuinely thought would never happen in my professional lifetime, and I feel it validates the years of care that I have taken in helping patients to not only heal, but to remain healed. After all, healing a pain will last only for so long, until the next injury; but the information will last a lifetime. What better way to care for a patient than to impart the power of self-healing?

Mr Vispi Jamooji DO, PG Cert SPOP  (1986)

More Information

Visit our Osteopathy Page
For free advice click here or call 02089462331.
New Patients: 60 minute appointment  – book here please

31st March 2018
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Office Chair Exercises

By Exercise, Pain Relief, Sports

Office Chair Exercises

by Hugo Firth, Osteopath

Back and Neck Exercise

90 Second Desk Exercise Workout

Want to know the best way to relieve stress at your desk? Our resident Sports and Exercise osteopath Hugo Firth has devised this special 90 second workout.  Hugo Firth brings together his life long skills of in sports together with his career as a successful Sports Osteopath. Quickly relieve tension and relax tired tissues. 

Do these exercises up to 6 times a day. Why not book bookmark this page and refer to it daily?

As with all exercises these must not be rushed and if symptoms persist you may wish to seek professional help. Why not contact Hugo for some friendly advice – click link below to use our online form:

Use our online form to ask us any quetion about your health or the health of a friend.

Top Tips

In the mean time here are some tip for general well being.

  1. Take a short break out of your chair every 60 mins or so. You may even wish to drink more water to prompt you to get up more often.
  2. Choose a variety of exercises throughout the week to help you keep fit. Try and avoid repetitive exercises, such as constant exposure to running, cycling or the same gym exercises. Postural variety is what keeps you going. 
  3. Avoid any prolonged activity, such as long periods of sitting, driving, or standing. Its hard to break this up if it is what you do for a living, but during your most stressful times, try and find a way around it. 
  4. Early nights help boost healing. So why not try a week of early night (just once, as a one-off) and we are sure you will be so impressed you will want to do that again. 
  5. Try and avoid soft deep chairs and settees. Contrary to popular belief soft squidgy chairs, beds and settees can be a source of hidden danger to the spine. If you are going through a bad time, try lying on your side or back to watch TV (or read), either on the settee or on the floor.

Hugo Firth BOst, BSc, MA
Osteopath and
Sports Rehab Specialist

Sports Osteopath Hugo Firth

Member of the General Osteopathic Council
Member of the Institute of Osteopaths
“My approach to healthcare is a balance between osteopathy and patient empowerment through effective therapeutic exercises. I recognise it’s not always possible to come in for a treatment, and many conditions can be helped with the right exercise if used early enough. After all prevention is much less painful than cure“.
I offer free advice via email, phone 0208962331 or by filling in this online form here
4th March 2018
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Pain Relief – Hot or Cold?

By Massage, Pain Relief, Sports

Self Help Pain Relief: Apply Hot or Cold?

Self help for pain relief

A frequent question I get asked shall I use a hot or cold compress? Firstly, let’s understand what each does?

Heat Therapy:

  • Improves circulation
  • Allows expansion of the vessels and tissues
  • Increases temperature
  • Soothe and relax muscle discomfort

You can use either dry heat (heat pad) or moist heat (hot baths, steam), both should aim or a ‘warm’ temperature not hot! A common mistake people make, which leads to burns! You can use local treatment for targeting one muscle, or a whole area targeting whole body stiffness.

When you should not use heat?

  • If you have bruising
  • Inflamed joints/area
  • Open wounds

Certain pre-existing conditions that may causing higher risk of burns or complications

  • Diabetes
  • Dermatitis
  • Vascular disease
  • Deep vein thrombosis
  • Multiple sclerosis

Cold Therapy:

  • Reducing blood flow
  • Contraction of blood vessels and tissues
  • Reducing inflammation
  • Relieve pain
  • Temporarily reduce nerve activity

You can use for local areas: ice packs, sprays, or whole body effect: ice baths, ice massage. During the first 72 hours of initial injury, can use ice three times a day for 10-15 minutes.

When should you not use ice?

  • Tight and stiff muscles
  • Feeling unwell (shivering cold)

Conclusion

As a general rule of thumb use cold therapy on a new injury. The first object is to reduce the inflammation, which is the body’s first response to injury. (Remember inflammation is a big source of pain).  It should be applied for up to 15 minutes only and usually no more than 4 times a day. 

If you are experiencing muscle spasm, then heat can be a great source of relief. Heat is generally best applied a few days after the acute injury has passed (ie giving time for the inflammation to subside).  As a general rule of thumb, if you feel like you need a massage, it probably means you are ready for a heat pack.

If you are unsure, always go for cold therapy first, as at the worst it will do you no harm. Where as applying heat to an inflamed area will increase the inflammation which will certainly add to the pain and stop you feeling better.  Also remember that generally speaking heat therapy works against medicines like Neurofen (ibuprofen), naproxyn, diclofenac etc. Always protect your body from direct sources of hot or cold as both can burn the skin, as mentioned above.  If this all sounds confusing or need personal advice – give us a call – we are always on hand to give free telephone advice – even if you are not a patient. So please share this blog or visit our pain relief page!

 

Osteopath, Wimbledon
Jennifer Beck, M.OST
Member of the General Osteopathic Council
Member of the Institute of Osteopaths

“I am available to help you today. Being gentle and working in tune with nature, it will be a relaxing way to heal“.
Jen.

Call anytime for an appointment of free telephone advice, 02089462331

 

24th February 2018
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Choosing Yoga or Pilates?

By Massage, Pain Relief, Sports

Choosing: Yoga or Pilates?Pilates & Yoga for back pain

You may think these are in the same exercise category, however they are rooted from very different histories. Read below to help determine which practice is right for you…

Yoga

This type of exercise originated in south Asia thousands of years ago, the purpose is the unite the mind, body and spirit. They use the whole body structure using the environment to heal the body and help mental harmony.

The different styles:

  • Anusara: Beginners class to yoga with physical practice to yoga
  • Bikram: ‘Hot Yoga’ series of 26 basic yoga postures, each performed twice
  • Hatha: Classical physical yoga practice using breathing and posture
  • Ashtanga: Six established and strenuous pose sequences
  • Lyengar: precise alignment and deliberate sequencing using props.
  • Kundalini: constantly moving, invigorating poses.
  • Vinyasa: Active and athletic style of yoga adapted from the traditional ashtanga system
  • Prenatal: yoga postures adapted for expecting mothers
  • Restorative: using less poses and increased breathing techniques.

Pilates:

This type of exercise was created by Joseph Pilates in the 1920’s. The purpose of Pilates is to gain flexibility, strength and body awareness. Although the routine is performed on a mat, there are specific Pilate’s machines; this type is called the Cadillac and reformer.

Types:

  • Mat Pilates: classical specific routine of movements and involves little or no equipment – heavily focuses on strengthening the core
  • Contemporary studio Pilates: fully equipped studio under expert instruction
  • Group reformer Pilates: dynamic, full body workout all with one piece of equipment (the Reformer)
  • Classical Pilates: fully equipped studio, with original series of movements in a specific order.

 

Questions you can ask yourself before choosing?

  1. Are you seeking exercise for a mental benefit? All exercise is linked with improving your mental health, yoga may be most effective for this as it focuses on the mind, body and spirit.
  2. What physical benefit are you hoping for? Pilates is known for focusing on core strength however yoga has an overall benefit.
  3. Have you currently got back pain? Some routines/positions can increase pain therefore informing your instructor of your current situation is important.
  4. No to props? Yoga using your body weight with a sequence of positions where Pilates uses different props to enhance the technique.

Ultimately the choice is yours, trying out both and deciding what works best for you. Yoga provides a meditative environment for you to improve overall quality of life, focuses on stress relief while improving our body. Pilates works from the centre of your body outwards, it forces to increase your body awareness. In my opinion, yoga is excellent for everyone by improving their mental health, but allowing a combination of Pilates to optimize your body function.

Osteopath, Wimbledon
Jennifer Beck, M.OST
Member of the General Osteopathic Council
Member of the Institute of Osteopaths

“I am available to help you today. Being gentle and working in tune with nature, it will be a relaxing way to heal“.
Jen.

Call anytime for an appointment of free telephone advice, 02089462331

 

2nd January 2018
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