Why do your knuckles pop?

February 13, 2016 in General Interest, Treatments

You may be a knuckle-cracker or you may hate people doing it (it’s a bit like Marmite I guess, you either love it or hate it) but why do knuckles pop? In fact we could ask the same question about most joints in our body. Joint “self-cracking” brings relief to some people while it’s just a habit for others. The most common joints to self-crack are those in the fingers. There are different theories why it may happen and the video below (worth watching – quite fun) explains some of them. The noise is not always due to the joint: sometimes it’s due to a tendon snapping over a bone.

Dr Unger, a very interesting medical doctor and probably a slightly stubborn one, cracked the knuckles of one of his hands for 50 years (approximately 36500 times) and did not crack the knuckles of his other hand to use it as a control. He found no difference between his hands. He published a letter in the leading journal in rheumatology. While it provides a low level of evidence, it’s nevertheless interesting to know if you are a knuckle cracker: next time you hear someone telling you that you’ll get arthritis if you keep doing it, you can tell them about Dr Unger’s experiment.

Referral from the osteopath to your GP or other health professionals

February 12, 2016 in General Interest, Treatments

As a primary healthcare professional your osteopath, in addition to their osteopathic skills, have been trained to undertake detailed medical histories and a comprehensive range of clinical examinations in an effort to diagnReferralose the cause of your symptoms.
It is due to this extensive training that they are able to determine if you may need to be referred on for further tests to determine an accurate diagnosis, or if your condition may require the intervention of another health professional.

When this happens your osteopath can write to your GP outlining their findings and requesting further investigations or referral to an appropriate consultant.

In addition to referring to your GP, many osteopaths know their local medical community well, so are well placed to recommend treatment from other health professionals who are able to treat specific conditions, or even another osteopath with specialist knowledge of the condition.

Before your osteopath makes any referral, they will discuss with you their diagnosis and explain why they feel you need help from someone else.

If you are happy to be referred they will ask your permission to write to the person they are referring you to with details of your case notes and any other information from their examination that they feel might help the clinician to treat you most effectively. This may help you to get better or faster treatment because the next person to see you won’t be starting from scratch and will have the benefit of another expert’s insight into your condition. If you prefer, you can ask for a copy of your notes to take to your GP or another doctor.

If you are referred, do keep your osteopath informed about your ongoing treatment, and feel free to continue to consult him or her about any other aches and pains you’re experiencing.

Persistent pain

August 31, 2015 in General Interest, Pain posts, Treatments

Chronic painWe all feel pain from time to time. When someone injures themselves, specific nerves recognise this as pain, which in turn triggers the body’s repair mechanism. As the problem resolves, the pain tends to improve and usually disappears within 3-6 months. This type of pain could be argued to be beneficial: if it hurts, you are likely to try and avoid doing whatever it is that has caused the pain in the future, so you are less likely to injure yourself in that way again.

Occasionally the pain continues even after tissue healing has finished. When pain continues after this point, it becomes known as persistent (or is sometimes referred to as chronic) pain. This type of pain is not beneficial and is a result of the nerves becoming over-sensitised, which means that a painful response will be triggered much more easily than normal. This can be unpleasant, but doesn’t necessarily mean that you are doing yourself any harm simply by moving. You could think of this as a sensitive car alarm that goes off in error when someone walks past (for more information on how pain works, visit: https://www.youtube.com/watch?v=QUrKgv43W2c ).

Persistent pain is very common and effects over 14 million people
in the UK alone. It often does not respond to conventional medical interventions and needs a different kind of approach, but there are many things that you can do to manage your pain yourself with the support of your osteopath, your family and loved-ones. Keeping active, performing exercises and stretches can help, learning to pace your activities so that you don’t trigger a flare-up of your pain as well as setting goals and priorities are all very important and can help you to maintain a fulfilling lifestyle.

For more information on how to manage your persistent pain, speak to your osteopath or visit http://www.paintoolkit.org/

Low back pain: what exercises can I do to help?

January 29, 2015 in Exercises, General Interest, Pain posts, Treatments

Back exercisesPatients often ask me “What can I do to avoid my back pain coming back?” An excellent question that probably sounds like easy to answer, and you would expect me or any other health professionals answer it easily. The trouble is, there is no definite answer or I should say there was no definite answer. There has been a debate for decades about whether we should stretch or strengthen bad backs. There were lots of different opinions but no clear evidence on which might be better. A very big study (1) was very recently published in one of the leading back research journals. They assessed whether strengthening or stretching was more effective for patients with recurrent episodes of low-back pain. To do this, they followed 600 hundred patients over 10 years. They were divided in four groups:

  • 150 patients performed strengthening exercises,
  • 150 patients performed stretching/flexibility exercises,
  • 150 patients performed strengthening exercises and used abdominal bracing* (this refers to contracting muscles – not to wearing a lumbar support! See at the end of the article for more information on bracing) in daily activities/exercises,
  • 150 patients performed flexibility exercises and used abdominal bracing in daily activities/exercises.

 

To compare the effects of these exercises, they assessed the 600 patients over 10 years on 6 outcomes:

  • frequency, intensity, and duration of pain,
  • frequency, intensity, and duration of exercises.

 

And their results were….. drum roll….

  • No differences between the strengthening and stretching groups
  • The bracing groups improved more than the non-bracing groups on: pain intensity (almost 2 times lower), pain frequency (more than 1.5 times lower) and pain duration (more than 1.5 times shorter)
  • Interestingly, the bracing groups did their exercises more frequently than the non-bracing groups. The intensity and duration were similar.

In other words, the activity performed by people who have recurrent low back pain may not be that relevant to pain outcomes but more how often the activity is performed! Of course the activity still needs to either strengthen or stretch (any kind of sport or classes including Pilates or Yoga, etc).

Abdominal bracing may be helpful, but in this study it may have played a role in reminding patients to perform their exercises regularly rather than having a mechanical effect. This study can’t tell us how abdominal bracing may have affected the outcomes.

 

Low back pain is affected by many factors other than purely mechanical ones (more information here). Tackling these factors alongside doing some physical activity would of course be more beneficial!

 

(1) Aleksiev, A. R. Ten-Year Follow-up of Strengthening Versus Flexibility Exercises With or Without Abdominal Bracing in Recurrent Low Back Pain. SPINE 2014;39(13):997 – 1003

 

* The authors define bracing as such: “The abdominal bracing groups received additional training to incorporate bracing in daily living activities and exercises without interrupting the breathing “brace and breathe.” The most important requirement was to initiate abdominal bracing immediately before any whole-body movement/exercise, shifting the body center of gravity away from the bearing surface. Bracing intensity and duration was dependent on the individual judgment and the situation—the higher/longer the physical demand the higher/longer the bracing intensity. Every patient received instructions to self-perform the learned bracing and/or exercise as frequently as possible throughout the day with self-judged duration and intensity.”

I have back pain – should I have an X-ray?

January 29, 2015 in General Interest, Pain posts, Treatments

Spinal curvesMost people consulting their GPs for low back pain won’t be offered an X-ray, MRI or CT-scan, and other healthcare professionals would not advise these patients to go and see their GP to get a prescription for an X-ray.

Why is this?

85% of people with low back pain are diagnosed with “non-specific low-back pain” which means that there are no underlying diseases responsible for the problem. For that reason, there is no need to look for tissue damage with an x-ray as we know that no specific tissues are responsible for the problems.

For the other 15%, the history-taking and examination would reveal signs suggesting something more serious and possibly responsible for the problem. Investigations would then be offered.

MRI lumbar spineTwenty years ago most patients with back pain used to be offered X-rays. They had pain, an X-ray or MRI or CT-scan would be performed and signs of degeneration were seen leading to the conclusion that the patient’s pain was caused by the degeneration in the back. In the 90’s, studies started to look with X-rays, MRI and CT-scans at the backs of people with no back pain. Interestingly, they had pretty similar backs to patients with pain. The logical conclusion is that the changes seen on these images do not explain most patients’ pain (apart from the 15% mentioned above for which we know that investigations are necessary). Performing X-rays on everyone with back pain had three negative effects:

  • unnecessarily irradiating patients who did not need an X-ray,
  • a financial impact on the NHS,
  • a nocebo effect. The nocebo effect is the opposite of the placebo effect in the sense that something that should be harmless causes symptoms. Patients started developing symptoms because they found out that there was some wear and tear in their spine and started believing that the pain was caused by this (which it is not!) This made it difficult to accept that the pain could improve, as the wear and tear would remain the same.

 

A systematic review of the literature (1) looked at all the studies on people with no back pain using either CT-scans or MRIs. Their conclusions are quite surprising.

In people with no back pain:

  • nearly 4 out of 10 people aged of 20 years old have disc degeneration and 96% of 80-year-old individuals have it.
  • 3 out of 10 twenty-year-olds have disc bulges and 8 out of 10 eighty-year-olds.
  • 3 out of 10 twenty-year-olds had disc protrusions and more than 4 out of 10 eighty-year-olds.
  • 2 out of 10 twenty-year-olds had signs of annular fissures and 3 out of 10 eighty-year-olds.

Sorry to repeat myself, but all of them were symptom-free! I’m not implying that disc degeneration / disc bulges / annular fissures are not painful, but most of us may have some discal changes that have already happened long before back pain. If we have discal changes but no pain, and later start having pain there may be another reason (or other reasons) than just what can be seen on an MRI or CT-scan!

Non-specific low-back pain is multifactorial (more information here) so we should not focus too much on MRI findings but more on how to improve the back’s function to get back to a normal life. There are several things we can do to help a bad back, including self-management (more information here) and seeking help from an osteopath of course! (more information here)

 

(1) W. Brinjikji, P.H. Luetmer, B. Comstock, B.W. Bresnahan, L.E. Chen, R.A. Deyo, S. Halabi, J.A. Turner, A.L. Avins, K. James, J.T. Wald, D.F. Kallmes, and J.G. Jarvik. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. AJNR Am J Neuroradiol 2014 Nov 27 [Epub ahead of print]

Plantar fasciitis – should we stretch or strengthen?

September 27, 2014 in Exercises, General Interest, Pain posts, Treatments

plantar fasciitis osteopathy treatmentPlantar fasciitis is the most common cause of heel pain. The plantar fascia is a strong band of tissue (like a ligament) that goes from the heel to the middle foot bones. It supports the arch of the foot and also acts as a shock-absorber.

When patients come to me with what appears to be plantar fasciitis, I like to look at the patient’s gait, how the patient walks and stands, and then I assess the mobility of the feet, ankles, legs, pelvis and back (amongst other things). I try to consider the different structures that may affect the plantar fascia and see how I may be able to help. After treatment, I give advice and exercises most of the time. The advice I give follows the recommendations of a recent study¹ that compared the effects of stretching the plantar fascia every day with high-load strength training every other day.

Both groups wore shoe inserts. The short term effects were significantly better for the stretching group but the middle and long term effects were better for the strengthening group.

Here is how the exercises were carried out (please note that this post is informative; if you experience similar symptoms, you need to have a proper diagnosis and a health professional to verify that these exercises are suitable for you):

– stretching:

plantar fasciitis stretching

– high load strengthening exercise:

Plantar fasciitis strength training

 

There are different things that need to be also be considered, such as your footwear and the impact of the physical things you do in your life on the plantar fascia. Osteopathy can help restore movement and function to decrease the load on the plantar fascia. More information on first appointments here.

 

1. M. S. Rathleff, C. M. Mølgaard, U. Fredberg, S. Kaalund, K. B. Andersen, T. T. Jensen, S. Aaskov andJ. L. Olesen. High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up. Scandinavian Journal of Medicine & Science in Sports; early view.

Chronic prostatitis / chronic pelvic pain syndrome and osteopathy

February 5, 2013 in General Interest, Pain posts, Treatments

Chronic prostatitis/chronic pelvic pain syndrome (or CP/CPPS) is a pelvic pain without evidence of urinary tract infection

 

The symptoms usually reported can be from slight discomfort to debilitating and may include back pain, fatigue, abdominal pain, constant burning pain in the penis. A frequent sign of CP/CPPS is post-ejaculatory pain.

A study, published in a serious journal and indexed in PubMed (the top quality database), has just been published on the effects on osteopathy on this condition. They followed patients for 5 years in order to compare the symptoms evolution with and without osteopathy. Osteopathy has been found to be helpful for CP/CPPS and osteopathic treatments effects last for at least 5 years. They recommend that patients should be  offered osteopathic treatments at an early stage of the condition.

 

More information on: http://www.ncbi.nlm.nih.gov/pubmed/23354911

 

chronic prostatitis pelvic pain osteopathy

Osteopathy and infantile colic

December 12, 2012 in babies, General Interest, Treatments

23maleostwithnewbornandmothAn interesting article has just been published: “Manipulative therapies may be a beneficial treatment for infantile colic”. LINK 

This research suggests that manual therapies, such as osteopathy, may be beneficial for babies with colic. Treatments meant babies cried fewer hours. This is really early evidence and more research is needed. The National Council for Osteopathic Research decided in 2015 to look at the evidence behind osteopathic treatments for babies. We are looking forward to the results!