Please feel free to scroll through my rather extensive blog - Philip

Hockey

Hockey relies heavily on both upper and lower body musculoskeletal anatomy, as well aerobic and cardiovascular endurance. Among the most critical muscles used are: abdominal muscles, oblique muscles, erector spinae muscles and associated back muscles, hip extensors including the gluteal and hamstring muscles and hip flexors and quadriceps muscles. Muscles of the core are particularly critical for hockey. Core muscles include the abdominal muscles (such as the rectus abdominus and more importantly, the transverse abdominus), and the internal and external oblique muscles. Quadriceps and gluteal muscles, particularly the gluteus maximus are relied on for power. The gluteus maximus is used to extend the leg at the hip. Quadriceps muscles in the thighs also play an important role. The inner thigh muscles are used in abduction. Among upper body muscles, the anterior and middle deltoids and biceps muscles are the most heavily used.

Most Common Hockey Injuries

Hockey players are prone to a variety of overuse injuries due to movement inherent in the game, as well as assorted acute or traumatic injuries. Back muscle strain or back ligament sprain, groin strains, hip flexor strain, adductor strain, and tendonitis of the hip, pelvis, and groin; hip, knee or shoulder injury, wrist, hand and finger injuries, head and neck injuries including concussion and assorted contusions are all commonplace. Risk of traumatic injury comes from possible impact with hockey sticks and balls. The most common injuries include:

• Contusions, which may occur in the upper or lower body

• Neck and spine injuries

• Knee injuries, particularly sprains to the medial collateral and capsular ligaments

• Shoulder injuries, including acromioclavicular, or AC joint separation, (also known as a separated shoulder) as well as shoulder dislocation

• Gamekeeper’s thumb, resulting from the tearing of the ulnar collateral ligament

• Fractures of the hand and wrist

• Concussion, ranging from mild to severe and involving brief to extended periods of unconsciousness.

Injuries to the shoulder joint occur frequently in the game. The shoulder joint is composed of the humeral head and the glenoid fossa of the scapula. This highly mobile joint is relatively exposed, making it highly vulnerable to injury. Subluxation of the shoulder occurs when the humeral head slips out of joint, occasionally causing temporary paralysis. Fractures of the clavicle are also a common affliction, requiring proper medical attention.

Injury Prevention Strategies

The following safety points should be strictly adhered to:

• Always properly warm-up (including practice skating) prior to play

• Allow an adequate cool-down period and perform after-game stretching

Three Hockey Stretches

Reaching Lateral Side Stretch: Stand with your feet shoulder width apart, then slowly bend to the side and reach over the top of your head with your hand. Do not bend forward.

Kneeling Quad Stretch: Kneel on one foot and the other knee. If needed, hold on to something to keep your balance and then push your hips forward.

Kneeling Heel-down Achilles Stretch: Kneel on one foot and place your body weight over your knee. Keep your heel on the ground and lean forward.

March 10th 2019

Yesterday I attended day 3 (the last day) of the New Zealand Pain Society Annual Scientific Meeting.

0900-0945: Bridging The Gap: How to Apply Best Evidence Practice in Community Settings

Professor Michael Nicholas, Director, Pain Education & Pain Management Programs, Pain Management Research Institute, The University of Sydney, NSW, Australia  

0945-1030: Back Pain - Don’t Take It Lying Down

Professor Rachelle Buchbinder, Senior Principal Research Fellow; Director, Monash Department of Clinical Epidemiology, Cabrini Institute, Monash University, Melbourne, Australia

1100-1115 Online Mindfulness and Gratitude Intervention for Persistent Pain (#40)

Associate Professor Nicola Swain, University of Otago, Dunedin, NZ

1115-1130 Do Online Resources Foster Self-Management Support in People with Persistent Pain?

Dr Hemakumar Devan, Postdoctoral Fellow, Centre for Health, Activity & Rehabilitation Research, University of Otago, Wellington, NZ

1130-1145: ‘My Shoulder has a Brain’: Feasibility of Neuroscience- Informed Physiotherapy for Persistent Shoulder Pain

Associate Professor Nicola Swain, University of Otago, Dunedin, NZ

1145-1230: Reflections on 23 years in Acute Pain Management

Richard Craig, Nurse Leader, Acute Pain Service, Christchurch Hospital, Christchurch, NZ

1330-1400: Summary /Review of the Evidence for the Role of Gabapentinoids in Pain

Dr John Alchin, Pain Physician, Pain Management Centre, Burwood Hospital, Christchurch, NZ

1400-1430: Summary /Review of the Evidence for Addiction to / Abuse of Gabapentinoids

Dr Tony Harley, Psychiatric Registrar, Community Alcohol and Drug Services, Christchurch, NZ

1430-1500: A Discussion of the Role and Use of Gabapentinoids in Pain, in the Light of the Abuse Potential

Panel Discussion

1530-1600: Is Pain Intensity the Best Measure of Pain Treatment Outcome?

Professor Jane Ballantyne, Anesthesiology and Pain Medicine, University of Washington, Seattle, USA

1600-1630: Panel Discussion with our Keynote Speakers

Professor Jane Ballantyne, Anesthesiology and Pain Medicine, University of Washington, Seattle, USA;Professor Fiona Blyth, Public Health and Pain Medicine, Head Concord Clinical School, Faculty of Medicine and Health University of Sydney, Concord, NSW,  Australia; Professor Rachelle Buchbinder, Senior Principal Research Fellow; Director, Monash Department of Clinical Epidemiology, Cabrini Institute, Monash University, Melbourne, Australia   and Professor Michael Nicholas, Director, Pain Education & Pain Management Programs, Pain Management Research Institute, The University of Sydney, NSW,

March 9th 2019

Yesterday I attended day 2 of the New Zealand Pain Society Annual Scientific Meeting.

0900-0905 Arthritis New Zealand Update

0905-0945 ACC Update – ePPOC

Janelle White, Quality Improvement, Research, Electronic Persistent Pain Outcomes Collaboration (ePPOC), Australian Health Services Research Institute (AHSRI), University of Wollongong, NSW, Australia

0945-1030 Update on Knee Arthroscopy for Pain

Professor Ian Harris, Orthopaedic Surgery, University of NSW, Sydney, Australia

1100-1145 Persistent Pain following Total Knee Arthroplasty

Associate Professor Gwyn Lewis, Neurophysiologist, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, NZ Chair: Dr John Alchin

1145-1230 Panel Discussion on Knee Arthroscopy

Associate Professor Gwyn Lewis, Neurophysiologist, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, NZ Professor Ian Harris, Orthopaedic Surgery, University of NSW, Sydney, Australia

1330-1415 Placebo and Outcomes

Professor Ian Harris, Orthopaedic Surgery, University of NSW, Sydney, Australia

1415-1500 How to Create a Health Scare

Professor Keith J. Petrie, Health Psychology, Department of Psychological Medicine, The University of Auckland, Auckland, NZ

1530-1615 RCT on Vertebroplasty and its Afterlife

Professor Rachelle Buchbinder, Senior Principal Research Fellow; Director, Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia

1615-1700 Panel Discussion

Professor Keith J. Petrie, Health Psychology, Department of Psychological Medicine, The University of Auckland, Auckland, NZ,Professor Rachelle Buchbinder, Senior Principal Research Fellow; Director, Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia Associate Professor Gwyn Lewis, Neurophysiologist, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, NZ

March 8th 2019

I have just been to the opening of the new osteopathy clinic and osteopathy technique practice rooms for the new osteopathy course at Ara Institute. They are in High Street and are very impressive. It was good to meet the second year and new first year students.

March 8th 2019

Yesterday I attended day 1 on the New Zealand Pain Society Annual Scientific Meeting.

These are the sessions I attended:

0900-0945: Chair: John Alchin

Dr Mike Butler, Retired, Consultant Rheumatologist and Pain Medicine Specialist, formally at Auckland DHB, NZ. A Senior Retired Pain Physician’s Personal Choice of Top Pain Researchers (basic and clinical) in the Latter Half of the 20th Century

1015-1100: Epidemiology of Pain

Professor Fiona Blyth, Public Health and Pain Medicine, Head Concord Clinical School, Faculty of Medicine and Health University of Sydney, Concord, NSW 2139, Australia

1100- 1200: PATRICK WALL LECTURE - Insights into the US Opioid Epidemic

Professor Jane Ballantyne, Anesthesiology and Pain Medicine, University of Washington, Seattle, USA

1300-1315: Illness Perceptions in Complex Regional Pain SyndromeB (#45) Dana Antunovich, The University of Auckland, Auckland, NZ

1315-1330: Factors Influencing Physiotherapy Rehabilitation in People with Persistent Pain from CALD Communities (#38)

Dr Hemakumar Devan, Postdoctoral Fellow, Centre for Health, Activity & Rehabilitation Research, University of Otago, Wellington, NZ

1330-1345: A Proposed Clinical Conceptual Model for the Physiotherapy Management of Complex Regional Pain Syndrome (#47)

Tracey Pons, Physiotherapy Specialist, University of Otago, Kaiapoi, NZ

1345-1400: Short Term Relief of Chronic Multi- Site Pain with Bowen Therapy (#16) Associate Professor Gwyn Lewis, Neurophysiologist, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, NZ

1400-1500: Cannabinoids in Pain

Dr John Alchin, Pain Physician, Pain Management Centre, Burwood Hospital, Christchurch, NZ

1530-1545: The Development and Maintenance of a Well- Functioning Chronic Pain Team (#9)

Heather Griffin, Physiotherapy Team Leader, Bay of Plenty DHB, Tauranga, NZ

1545-1600: Have Our Chronic Pain Management Programmes Progressed? A Mapping Review (#18)

Associate Professor Gwyn Lewis, Neurophysiologist, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, NZ

1600-1630: Burwood Advancement Screening Education (BASE) Seminar: How Changing a Service Gateway Changed a Service

Bronny Trewin, Senior Clinical Psychologist, Pain Management Centre, Burwood Hospital, Christchurch, NZ: Dr Ian Holding, Musculoskeletal Specialist and General Practitioner, Pain Management Centre, Burwood Hospital, Christchurch, NZ

1630-1700: Interprofessional Teamwork: Working Within and Across Multidisciplinary Treatment Teams Bronny Trewin, Senior Clinical Psychologist, Pain Management Centre, Burwood Hospital, Christchurch, NZ

Dr Bronnie Lennox Thompson, Academic Coordinator, Senior Lecturer, Orthopaedic Surgery & Musculoskeletal Medicine, University of Otago, Christchurch, NZ

March 7th 2019

Rotator Cuff Injury and Shoulder Tendonitis

The rotator cuff is a group of four muscles that helps to lift your arm up over your head and also rotate it toward and away from your body. Unfortunately, it is also a group of muscles that is frequently injured by tears, tendonitis, impingement, bursitis, and strains. The major muscle that is usually involved is called the supraspinatus muscle. The other rotator cuff muscle are: subscapularis, infraspinatus, and teres minor

Rotator cuff problems are usually broken up into the following categories listed below. If you’re not sure which one of these you have, start with rotator cuff tendonitis.

 Rotator cuff tendonitis

This is also known as impingement syndrome or shoulder bursitis. Usually this occurs in people 30-80 years of age, and usually the weakness in the shoulder is only mild to moderate. Rotator cuff tendonitis, also known as “bursitis” or “impingement syndrome” occurs when the rotator cuff gets irritated on the under surface of the acromion. The reason this begins in the first place is a source of some debate. Some people are born with a “hooked” acromion that will predispose them to this problem. Others have rotator cuff weakness that causes the humerus to ride up and pinch the cuff. This means that the bursa — a water-balloon type structure that acts as a cushion between the rotator cuff and acromion/humerus — gets inflamed.

Common symptoms of rotator cuff tendonitis include:

  • Pain. Pain located primarily on top and in the front of your shoulder. Sometimes you can have pain at the side of your shoulder. Usually is worse with any overhead activity (reaching up above the level of your shoulder).
  • Weakness. Mild to moderate weakness, especially worse with overhead activity.
  • Popping. Sometimes bursitis that occurs with rotator cuff tendonitis can cause a mild popping or crackling sensation in the shoulder.
  • Unable to Sleep on Shoulder. Most patients complain of difficulty sleeping on the shoulder at night.

How is impingement syndrome diagnosed?

Often, the diagnosis is suggested by your symptoms. Your osteopath can have you perform various manoeuvres to detect this problem. This physical examination is designed to test your motion, strength, and certain positions of pain. In addition, plain x-rays can show a spur on the under surface of the acromion. An MRI is occasionally ordered if a rotator cuff tear is suspected.

How do we treat rotator cuff tendonitis?

  • Just about all orthopaedic surgeons agree that this problem should be initially treated conservatively (i.e., without surgery). What are the steps to healing?
  • Stop any activities that can aggravate your symptoms. For example, if you’re painting the ceiling in your garage and it’s making your shoulder feel worse, stop doing it!
  • Do not ignore your body. It is telling you (with pain) that something is wrong.
  • Take medications, if necessary, to make you comfortable and decrease your pain.
  • Consider using cryotherapy (cold therapy) to get your pain under control.
  • STRENGTHEN your rotator cuff!

Why does strengthening the rotator cuff muscles work? When you have this tendonitis you get into a “vicious cycle”:

  1. First your rotator cuff is irritated for various reasons (e.g., overuse, injury, etc.).
  2. Then it doesn’t work as well, and that causes increased pressure under the acromion bone.
  3. The only way the acromion can react to that is to make new bone (a bone spur!).
  4. That bone spur then presses on the rotator cuff.
  5. So the rotator cuff gets MORE irritated, and then more weak, and so on (go back to

Strengthening your rotator cuff is the scientifically proven way to break this vicious cycle. Osteopaths agree that exercise for the rotator cuff muscles (e.g., stretching and strengthening) is the most important first step in treating impingement syndrome/rotator cuff tendonitis/bursitis.

Rotator cuff tears

These occur usually in people who have had tendonitis for a while and are starting to experience more weakness. It can also happen in someone who tries to lift something too heavy and feels a pop in the shoulder. A rotator cuff tear occurs when the tendonitis in the rotator cuff gets so bad that it wears a hole through the rotator cuff tendon. Since the tendon is what connects the rotator cuff muscle to your humerus bone, when the tendon is torn, you have weakness in the shoulder. Usually these tears occur in people who have had shoulder pain for some time (called a “chronic rotator cuff tear”). This is, by far, the most common type of rotator cuff tear. However, tears sometimes happen in people who do not have a history of shoulder problems. These people try to lift something that is too heavy and feel a pop in their shoulder, usually with immediate pain (this is called an “acute rotator cuff tear”). Usually the diagnosis is made with an examination by your osteopath. He or she can do special tests to determine how weak your rotator cuff muscles are. In addition, the doctor can check your motion to see if stiffness has developed. X-rays can show bone spurs in people with rotator cuff tears. Often these bone spurs helped to create the tear. Sometimes an MRI is ordered. This can show the osteopath with great detail the rotator cuff tendon and where it is torn. If your osteopath suspects a partial thickness tear (the tendon is not torn all the way through, just part of the way), an MR-arthrogram may be recommended (with consultant referral). This involves an injection into your shoulder before the regular MRI.

Treating the torn rotator cuff usually involves the following:

  • Control your pain. Over-the-counter medicines or prescription medication is given to help to relieve pain. In addition, cold therapy (cryotherapy) can help to decrease the pain and local swelling. Avoid activities that can worsen your pain, particularly overhead activities, repetitive motions, and heavy lifting. Do not put your arm in one position for a long time, keep it mobile. Your physician may give you a steroid injection into your shoulder area to also help improve the pain. Most osteopaths recommend that you get no more than one or two of these a year, as they do have the potential to weaken your tendons (every person is different, however, and you should check with your osteopath).
  • Regain motion. It is critical to regain the motion lost as a consequence of having this tear of the cuff muscle/tendon. Strengthen the other muscles of the rotator cuff that are not torn. These muscles can help to compensate for the torn muscle. Because there are four muscles in the rotator cuff, and usually only one is torn, sometimes strengthening the others is all you need to return to pain-free function.
  • Sometimes, if all this fails to relieve your pain, rotator cuff repair surgery might be needed to re-attach the torn tendon. There are lots of pros and cons to surgery, and different people need surgery for different reasons; be sure to discuss this with your osteopath. The bottom line is that many people recover from a rotator cuff tear without surgery.

Instability impingement

Mainly occurs in younger patients, typically 15-30 years old. The rotator cuff is irritated because the shoulder is loose in the socket. This often happens in baseball pitchers, swimmers, and other throwing athletes. The pain of both of these types of bursitis is usually better with rest or even using some heat over the areas of pain. This is the most common type of bursitis. An infection to the bursa usually has redness associated with this swelling and the pain is constant. If you think you may have an infection, please seek medical treatment immediately.

Shoulder instability can be classified into two different types, dislocations and subluxations.

  • Dislocations. This happens when the head of the humerus completely pops out of the socket. The first few times this happens, it is usually with significant trauma (although some people can have these without any injury at all). After that, it can get easier and easier for the joint to dislocate. Most shoulder dislocations are anterior. This means that the ball pops out the front of the socket.
  • Subluxations. This is the feeling that the shoulder slips slightly out of socket, then immediately comes back in place. This often happens without any major trauma. Sometimes it happens in people who are very “loose-jointed”. Sometimes these happen in just one direction (like out the front, or anterior), and other times they happen out multiple directions (e.g., front, anterior and back, posterior). This is called “multidirectional instability”. Most often, a diagnosis of recurrent shoulder dislocations can be made by simply listening to the patient’s symptoms. These patients will come in stating that their shoulder pops out of socket, and either goes back in by itself, or has to be put back in by someone else. Sometimes, the tricky part is knowing which way the shoulder is coming out of the socket. It can come out the front (“anterior”) or the back (“posterior”) or both (“multidirectional”). Your osteopath may order x-rays, and sometimes an MRI, to get a better idea of what is causing your dislocations (e.g., a torn cartilage, loose ligaments, etc.). Diagnosing subluxations can be more tricky. There are physical examination manoeuvres that your osteopath can perform to get a better idea if your shoulder is loose. Sometimes, however, it is not always clear; people with subluxations may not know their shoulder is subluxating, they may simply experience pain. An MRI can occasionally be helpful in this diagnosis.

Shoulder Instability Treatment

Most osteopaths will agree that treatment of most shoulder dislocations and subluxations should initially be conservative, that is, without surgery. If this was your first dislocation, especially if you had an anterior shoulder dislocation, your osteopath will usually recommend that you wear a shoulder sling for up to three weeks (depending on how old you are; be sure to follow your doctor’s direction). Controlling your pain will be important. Cryotherapy can help in relieving pain and swelling. Next, you need to regain motion if you have gotten stiff. Be sure to follow your doctor’s instructions on when and how to do this. Our deluxe shoulder therapy kit is a great device to help you get your motion back. Now comes the most important step: Strengthening your shoulder to prevent recurrent dislocations or subluxations: Strengthening the rotator cuff muscles is the scientifically proven way to help reduce your chance of re-dislocating or subluxating your shoulder. Because the rotator cuff muscles surround your shoulder, by strengthening them you help to improve the stability of the shoulder. Indeed, the muscles can sense when your shoulder is about to come out of socket and activate to try to prevent it. Strengthening your shoulder is more than just going to the gym and doing military presses. Most exercises that body-builders perform do not strengthen the rotator cuff. If all this fails, then surgery to correct the dislocating shoulder may be an option.

Exercises

The major objectives of rehabilitation from a rotator cuff injury are to increase flexibility, obtain pain-free range of motion, and strengthen the muscles of the shoulders, upper back, front chest, and upper arms. In severe cases, you should avoid activity that causes shoulder pain altogether. In these cases, you can still maintain cardiovascular fitness by cycling, unless otherwise prescribed by your doctor.

Stretching and strengthening of the 4 shoulder rotator cuff muscles (subscapularis, infraspinatus, supraspinatus and teres minor - for diagram, see link I’ve given to Marc’s post. There he gives a good website outlying the basic anatomy of the shoulder musculature), as already mentioned the foundation of rehabilitation of rotator cuff injuries. Initially, soon after injury, after the pain has died down a little, it is best to start performing shoulder exercises to maintain the range of motion in the shoulder and prevent scarring from the inflammation. This is best performed initially by isolating each muscle group and selectively training that muscle (known as Isometrics) - with no weights.

Phase 1 - Isometric exercises.

The subscapularis is the anterior stabilizer of the rotator cuff and responsible for internally rotating the shoulder. It is best strengthened by holding your arm in front of the body, with the arm flexed to 90 degrees, and rotating the hand to touch the belt. The exercise can be performed while lying on your back with the elbow close to your side and flexed ninety degrees. Lift the weight until it is pointing toward the ceiling and then lower it slowly. Add small amounts of weight as you progress, making sure you are in minimal pain at all times. If it gets too painful, stop and rest.

The supraspinatus is strengthened by holding out your arm straight in front of the body, with the thumbs pointed toward the floor. Slowly elevate the weight to above the head. Stop if pain is produced in any portion of this motion, as the rotator cuff is under maximal stress in this position. As you feel better, you can slowly introduce small amounts of weight to continue strengthening of the muscles.

The infraspinatus is strengthened by holding your arm (and later on, a weight) in the position of the ski pole just prior to planting the pole. By rotating the arm from the neutral straight ahead position, to the externally rotated (out to the side) position, the infraspinatus and teres minor are strengthened. Again, this exercise can also be performed while lying on your side with the elbow close to your hip, and flexed ninety degrees. Rotate the weight until it is pointing toward the ceiling. Shoulder exercises are best performed with relatively light weights and multiple repetitions. The logic behind stretching and strengthening the inflamed rotator cuff in order to speed healing and functional performance is as follows: the inflamed tissue is characterized by increased fluid between the cells, increased numbers of new blood vessels and inflammatory type cells. As a result of this inflammatory reaction, new collagen tissue is laid down in an effort by the body to heal the injured tissue. If the shoulder is immobilized during this time, the new collagen is laid down in a disorganized fashion, creating scar. The goal of gentle stretching, strengthening and anti-inflammatory medication, is to stimulate the cells to lay down collagen along the lines of stress, forming normal strong tendons. The combination of a good warm up, gentle stretching,  strengthening below the limits of pain, icing after working out and anti-inflammatory medication has been consistently shown to speed recovery time in the strongest possible fashion. After you are comfortable with these stretches and have minimal pain and good/fair range of motion in your shoulder, you can move onto resistance exercises. These usually start with what is known as tubing exercises. The ‘tubing’ is also known as a theraband, which is just a big rubber elastic band that you tie, at one end, to something and you hold the other end and pull the band thereby stretching it and providing resistance for your shoulder.

Phase 2 - Tubing exercises

External rotation: Stand resting the hand of your injured side against your stomach. With that hand grasp tubing that is connected to a doorknob or other object at waist level. Keeping your elbow in at your side, rotate your arm outward and away from your waist. Make sure you keep your elbow bent 90 degrees and your forearm parallel to the floor. Repeat 10 times. Build up to 3 sets of 10.

Internal rotation: Using tubing connected to a door knob or other object at waist level, keep your elbow in at your side and rotate your arm inward across your body. Make sure you keep your forearm parallel to the floor. Do 3 sets of 10.

Extension: Same principles as the other two. Keep the arm parallel. 3 sets of 10.  As you feel more confident and you find your strength increasing, you can add more resistance - either in terms of shortening the length of the theraband so you need more resistance to stretch it or by increasing hand held weights in small increments.

Overhead stretch

Lie on your back with your arms at your sides. Lift one arm straight up and over your head. Grab your elbow with your other arm and exert gentle pressure to stretch the arm as far as you can.

Cross-body reach

Stand and lift one arm straight out to the side. Keeping the arm at the same height, bring it to the front and across your body. As it passes the front of your body, grab the elbow with your other arm and exert gentle pressure to stretch the shoulder.

Towel stretch

Drape a towel over the opposite shoulder, and grab it with your hand behind your back. Gently pull the towel upward with your other hand. You should feel the stretch in your shoulder and upper arm.

Shrugs

Stand with hands at sides with no weight in either hand. Raise shoulders to the point of pain and hold for five seconds. Relax for five seconds. Perform this sequence 10 times, 3 times daily. As pain permits, hold dumbbells of equal weight in each hand while performing this exercise. Add weight by using hand-held dumbbells as pain permits.

Bicep curls

Stand with arms fully extended at sides while grasping 2- to 5-pound weights in each hand, held palm forward. Flex the arms at the elbow to approximately 100 degrees, or to the point of pain, whichever comes first. Hold this position for 5 to 10 seconds. Return to the start position. Rest for 5 seconds. Repeat this exercise 10 times. You can increase the weight as pain allows and strength develops.

Triceps curls

Stand with elbows directed upward over the shoulders and with arms relaxed. Extend arms at the elbow so that the hands proceed upward to the point of pain. Hold this position for five seconds. Return to the starting position and relax for five seconds. Perform this sequence 10 times, 3 times daily. As pain permits, add weight by using hand-held dumbbells.

Chest raises

Lie on belly with hands extended along sides of the body. Raise the upper chest from the floor to the point of pain and hold this position for 5 seconds. Return to the start position and relax for 10 seconds. Repeat this sequence 10 times, 3 times daily.

Saws

Reach out and place the unaffected side hand on a corner of a table. Bend at the waist. Flex the injured side arm at the elbow and pull the injured side arm backward and upward as if sawing wood. Slowly bring the shoulder blades as close together as pain will permit. Slowly bring the injured side arm down to its beginning position. Repeat this sequence 10 times, at least three times daily.

Pendulum swings

Stand with the hand of the unaffected arm resting on the corner of a table and supporting some of the body weight. Slightly bend the knee on the unaffected side and extend the other leg sideways. Allow the injured arm to hang loosely over the unaffected side foot. By shifting the body weight, cause the relaxed injured arm to swing in circles to the fullest extent possible as limited by pain. Perform 25 swings in a clockwise direction. Allow the injured arm to cease swinging. Perform 25 swings of the injured arm in a counter clockwise direction. Repeat this sequence at least three times daily.

Flexed elbow pull

Bend and raise the injured side elbow to shoulder height. Grasp the injured side elbow with the uninjured side hand. Gently pull the injured side elbow toward the opposite shoulder until limited by first significant pain. Hold this position for 10 seconds. Relax for 10 seconds. Repeat this sequence 10 times at least three times daily.

People often say, when can I start weight training again? Or when can I return to sport? There is no definite answer for that. It depends on the degree of your injury, how dedicated you are to your rehab and the rate at which your body heals. Some people with minor tears can return to full contact sports in as short as 4 weeks. Other with larger tears has to have surgery and can be out for a year. My advice to you is, don’t rush it. Let your body take its time to heal. Do your exercises, have osteopathy, and the results will come with time. Impatience is one of the biggest causes of re-injury. And most importantly, always consult your osteopath for advice. While I can help you on these downloads and point you in a right direction, nothing can replace a one-on-one physical examination and a good chat with your osteopath.

March 6th 2019

Osgood-Schlatters Disease

Osgood-Schlatters Disease is a common cause of knee pain in late adolescent and early teenage boys. The condition is less prevalent in females, although being active in sports increases a young female’s chances. This condition was named for the two doctors who defined the condition, simultaneously, in 1908; Dr. Robert Osgood and Dr. Carl Schlatter.

Anatomy Involved

The quadriceps tendon attaches to the patella (knee cap) and then continues down to the top of the tibia as the patellar tendon. When the quadriceps muscle flexes it shortens pulling upward on the tendon, which in turn causes the tendon to pull up on the tibia, causing the lower leg to extend. As with any attachment it is under considerable stress when forcibly extending the knee or supporting the bodyweight during dynamic activities. Repetitive forceful contractions of the quadriceps can cause tiny avulsion fractures at the tendon attachment on the tibia. The bone will attempt to repair itself by adding more calcium to the area to protect and strengthen the attachment. This causes the lump under the knee often associated with Osgood-Schlatters Disease. When an adolescent or young teen goes through a growth spurt the muscles often struggle to keep pace with the growing bones and therefore are often too short compared  with the accompanying bones. This places additional stress on the attachments and happens often with the femur and quadriceps muscle. The femur grows quickly and the quadriceps does not stretch so the muscle is tight until it has a chance to adapt to the new growth. This puts a chronic strain on the quadriceps and patellar tendon. This stress leads to those tiny fractures at the attachment site when the muscle is under stress. These lead to the calcium loading at the site and pain and inflammation result.

Causes of Osgood-Schlatters

Osgood-Schlatters may be caused by any condition that puts extra stress on the patellar tendon resulting in small breaks at the attachment site. Some of the common causes:

  • A growth spurt or rapid lengthening of the femur, causing the quadriceps to be tight.
  • Repetitive stress to the patellar tendon through knee flexion and extension, such as with kicking or landing when jumping.
  • Chronically tight quadriceps as seen with weight training without proper flexibility training as well.
  • Untreated injury to the knee causing small avulsion fractures to the patellar tendon attachment on the tibia

Signs and Symptoms

Knee pain without an apparent direct cause or pain in the knee during and after exercise may be a sign of Osgood-Schlatters Disease. Although the symptoms may be similar to other conditions, such as patellar tendonitis, in younger athletes this condition should be considered. Some of the common signs and symptoms of this disorder include:

  • Pain below the knee cap, worsens with exercise or when contracting the quadriceps.
  • Swelling and tenderness below the knee.
  • A bony prominence may be noted under the knee as the condition advances.
  • A “grinding” or stretching sensation may be noted at the tendons attachment site.

Osgood-Schlatters Prevention

Preventing Osgood-Schlatters Disease involves avoiding or changing the conditions that lead to it. Knowing that chronic stress on the tendon and attachment causes this disorder, it is important to reduce that stress. Some of the strategies for prevention include:

  • Proper warm-up techniques will help prepare the muscles and tendons for the activity and increase the flexibility of the tendon. Warmer tendons are more flexible tendons.
  • If particular activities cause pain they are probably causing stress on the area. Reducing or avoiding these activities will help prevent the development of this condition. It is important to distinguish between healthy muscle pain and pain of injury. If it is stiffness and pain in the belly of the muscle and goes away in 24 hours it is simply pain from muscle breakdown and recovery, if it does not go away in a day or two, or is focused around a joint or bone attachment it may be the result of an injury.
  • Since a lot of the stress placed on the quadriceps and patellar tendons is due to tight quadriceps muscles, stretching these muscles to relieve the tightness and to lengthen the muscle will help alleviate some of the stress. Developing a balance between the hamstrings and quadriceps is also important. If the hamstrings are proportionately weaker than the quadriceps then they will not be able to act as a counter force against the forceful quadriceps contractions, which could put additional stress on the tendon. If the quadriceps muscles are weaker than the hamstrings (very rare) they will be chronically tight from resisting the hamstrings. Strengthening the quadriceps also helps facilitate muscle lengthening and increases flexibility if done properly through a full range of motion.

Exercises for Osgood Schlatters disease

The following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your osteopath prior to beginning them. Generally, they should be performed 3 times daily and only provided they do not cause or increase symptoms.

Static Quadriceps Contraction

Begin this exercise by sitting with your leg straight in front of you (figure 2). Tighten the muscle at the front of your thigh (quadriceps) by pushing your knee down into a towel. Put your fingers on your inner quadriceps to feel the muscle tighten during contraction. Hold for 5 seconds and repeat 10 times as hard as possible pain free.

Quadriceps Stretch

Begin this exercise by holding a chair or table for balance. Take your heel towards your bottom, keeping your knees together and your back straight until you feel a gentle stretch in the front of your thigh or as far as you can go without pain. Hold for 15 seconds and repeat 4 times at a mild to moderate stretch pain-free.

March 5th 2019

Groin Strain

Depending on the severity, a groin strain can range from a slight stretching, to a complete rupture of the muscles that attach the pubic (pelvis) bone to the thigh (femur) bone. A groin strain specifically affects the “Adductor” muscles. (Adductor; meaning, moves part closer to the midline, or middle of the body) These muscles are located on the inside of the thigh, and help to bring the legs together. The adductor muscles consist of “Adductor Brevis”, “Adductor Magnus” and “Adductor Longus,” all of which are displayed in the picture to the right. Adductor Longus has been cut to display the muscles underneath.  Of these three, it is Adductor Longus that is most susceptible to injury, and the most common place of injury on Adductor Longus is the point at which the muscle and tendon attach to the femur (thigh) bone. When a muscle is strained, the muscle is stretched too far. Less severe strains pull the muscle beyond their normal excursion. More severe strains tear the muscle fibres, and can even cause a complete tear of the muscle. Most commonly, groin strains are minor tears of some muscle fibres, but the bulk of the muscle tissue remains intact.

What Causes a Groin Strain?

Competitors that participate in sports that require a lot of running or rapid change in direction are most susceptible to groin injuries. Other activities like kicking, jumping and rapid acceleration or deceleration also place a lot of strain on the groin muscles. Another activity that puts a lot of strain on the groin is any movement that results in a sudden pressure being applied. Such as a fall, landing awkwardly, twisting, or bending while stress is applied to the groin muscles.

What are the symptoms of a groin strain?

An acute groin pull can be quite painful, depending on the severity of the injury. Groin pulls are usually graded as follows:

  • Grade I Groin Strain: Mild discomfort, often no disability. Usually does not limit activity.
  • Grade II Groin Strain: Moderate discomfort, can limit ability to perform activities such as running and jumping. May have moderate swelling and bruising associated.
  • Grade III Groin Strain: Severe injury that can cause pain with walking. Often patients complain of muscle spasm, swelling, and significant.

How to Prevent a Groin Strain?

The basis of prevention comes down to two simple factors. A thorough warm-up and physical conditioning, ie: flexibility & strength. Firstly, a thorough and correct warm up will help to prepare the muscles and tendons for any activity to come. Secondly, flexible muscles and tendons are extremely important in the prevention of most strain or sprain injuries. When muscles and tendons are tight and stiff, it is quite easy for those muscles and tendons to be pushed beyond their natural range of movement, which can cause strains, sprains, and pulled muscles. To keep your muscles and tendons flexible and supple, it is important to undertake a structured stretching routine.

Exercises

Athletes who sustain a groin strain will need osteopathy and incorporate a stretching program as part of their rehabilitation. Some simple stretches can help ease the symptoms of a groin strain. Furthermore, stretching can be a useful part of preventing groin injuries from occurring. As a general rule, the stretches should not hurt. There should be a gentle pulling sensation of the muscle, but this should not be painful.

The squatting adductor stretch:

  • Squat to the ground with your arms between your legs.
  • Allow your knees to move outwards.
  • Stretch your legs apart by pushing out with your elbows.

The butterfly stretch

  • This is done in a sitting position.
  • Sit with your feet together and knees bent. Grasp your feet with your hands.
  • Stretch your knees down towards the ground.
  • Do not bounce. Feel the stretch along your inner thigh.

The adductor stretch

  • This is done while standing.
  • Stretch one leg out to the side, keeping your other leg under your torso.
  • Bend the knee underneath your torso to stretch the muscles of the inner thigh of the opposite leg.
  • Your outstretched leg should have a straight knee, and you should feel the stretch on the inner thigh.

The cross-leg stretch

  • This is done while sitting.
  • While sitting in a chair, cross one leg over the other.
  • Press the knee of the crossed leg down towards the ground.
  • This stretch will emphasize the muscles of the inner thigh and front of the thigh.
March 4th 2019

Achilles Tendonitis

Achilles injuries are commonly associated with sports that require a lot of running, jumping and change of direction. Excessive twisting or turning of the ankle and foot can result in a rupture or strain. The sports that are most susceptible to Achilles injury include running, walking, cycling, football, basketball and tennis.

What is an Achilles tendon Injury?

The Achilles tendon is located at the rear (posterior) of the bottom half of the lower leg. It is a thick band of connective fibre that runs from bottom of the Gastrocnemius muscle to the heel bone. The Achilles tendon is used to plantar flex the foot, or point the foot downward. This allows a person the run, jump and stand on one’s toes. The Achilles tendon is the strongest tendon of the body, and able to withstand a 500Kg force without tearing. Despite this, the Achilles ruptures more frequently than any other tendon because of the tremendous pressures placed on it during competitive sports. There are two main types of injuries that affect the Achilles tendon; Achilles Tendonitis and Achilles Tendon Rupture. Achilles Tendonitis is simply an inflammation of the tendon, and in most cases is caused by excessive training over an extended period of time. Achilles Tendon Rupture, on the other hand, is a tear (or complete snapping) of the tendon, and usually occurs as the result of a sudden or unexpected force. In the case of a complete rupture, the only treatment available is to place the lower leg in a plaster cast for 6 to 8 weeks, or surgery.

Causes and Risk Factors

There are a number of causes and risk factors associated with Achilles Tendonitis. One of the most common causes is simply a lack of conditioning. If the tendon, and muscles that connect to the tendon, have not been trained or conditioned, this can lead to a weakness that may result in an Achilles injury. Overtraining is also associated with Achilles Tendonitis. Doing too much, too soon places excessive strain on the Achilles tendon and doesn’t allow the tendon enough time to recovery properly. Over time small tears and general degeneration result in a weakening of the tendon, which leads to inflammation and pain. Other causes of Achilles injury include a lack of warming up and stretching. Wearing inadequate footwear, running or training on uneven ground, and simply standing on, or in something you’re not meant to. Biomechanical problems such as high arched feet or flat feet can also lead to Achilles injuries.

How to prevent Achilles Tendonitis

1. Warm Up properly

A good warm up is essential in getting the body ready for any activity. A well- structured warm up will prepare your heart, lungs, muscles, joints and your mind for strenuous activity. Plyometric drills include jumping, skipping, bounding, and hopping type activities. These explosive types of exercises help to condition and prepare the muscles, tendons and ligaments in the lower leg and ankle joint.

2. Balancing Exercises

Any activity that challenges your ability to balance, and keep your balance, will help what’s called proprioception: - your body’s ability to know where it’s limbs are at any given time.

3. Stretching exercises

Towel Stretch:

This simple Achilles tendonitis exercise can be done by anyone whether you are suffering from tendonitis or not. As the name suggests you will need a towel for this exercise. Sit on a hard floor and spread one of your leg outside, but keep your other leg folded. Now loop the towel around the toes and ball of the spread leg. Then pull the towel towards you, but be careful that you do not bend your knee. You can hold this position for 20-25 seconds. Repeat this exercise 3-4 times.

Calf Stretch:

This exercise will help you release the strain on the tendon. Face a wall and place your hands on the wall at eye level. Take a deep lunge with the back leg heel touching the ground. Place the back leg as though it were slightly pigeon toed. Now slowly push your weight on the wall and feel the stretch on the back leg. Hold this stretch for 20 seconds. Change the legs and repeat the same for the other leg as well. Repeat 3-4 times on each of the legs.

Leg Lift:

This is also called ‘Side-lying leg lift’. Lie on your uninjured side. Keep your body in straight line. Place both the legs on top of one another. Now tighten the quadriceps muscle of the leg on top, then lift the leg off ground to make 45-60 degree angle with the leg below. Again do not bend either of the legs in the knee. Hold the leg in the same position till you count 20 and slowly bring it down. Repeat this exercise 3 times.

Heel Raise:

One of the easiest of the Achilles tendonitis exercises. Take support of a wall or a chair and raise your body and balance all the weight on your toes. Count for 5 counts and slowly come down. Repeat for 5 times. When the pain reduces, you can try bringing only one leg down at a time and balance all the weight on one leg.

Quadriceps Stretch:

Hold a wall or a chair. Stand on the uninjured leg. Hold the foot of the injured leg and slowly pull the heel of the injured leg towards the buttocks. Stay in this position for 15-20 seconds. The stretch is felt in the quadriceps and on the Achilles tendons. Repeat the quadriceps stretch 8-10 times.

4. Strengthening exercises

The Eccentric Knee Squat

To complete the Eccentric Knee Squat, stand facing a wall with posture erect, feet shoulder-width apart, and your toes just a few inches from the wall. Then, simply bend your legs at the knees, while keeping your upper body upright, so that your knees lightly touch the wall. You may have to adjust the distance from your feet to the wall to accomplish this effectively. Return to the starting position, and then bend your legs at the knees again, but this time point your knees to the left as you move them toward the wall. Note that this produces a dandy ‘eversion’ (outward movement) of the right heel, which is exactly what happens to your heel when you pronate during the stance phase of running. What happens is that this motion replicates the twisting forces applied to the Achilles and calves during running, helping them to fortify themselves in a rotational as well as straight- ahead plane. Return to the starting position, and then bend your legs at the knees again, but this time move your knees toward the right, giving your left heel a nice eversion. Come back to the starting position to finish the cycle (straight-ahead, left, and right). Repeat several more times, and your first experience with the Eccentric Knee Squat is over. Over time, the two-footed Eccentric Knee Squat will become easy for you. That will be the signal for you to abandon the two-footed version of this exercise and move on to the one-footed Eccentric Knee Squat. This squat is exactly like the two-footed exertion, except that now full body weight is on one foot, as it is when you run. You repeat the same pattern (straight-ahead, left, and right) which you used for two-footed eccentric squatting, carry out several reps on one foot, and then move over to the other one. The toe of the non-weight-bearing foot can be tucked neatly against the heel of the weight-bearing foot as you complete the drill. You’ll soon find that the one-footed knee squat is an absolutely dynamite activity for boosting Achilles and calf strength - in the same planes of motion (front to back, side to side, and rotational) which are present during the stance phase of running!

The Balance and Eccentric Reach with Toes

Start by standing on your right foot only as you face a wall, with your right foot about 75 cms or so from the wall (you may need to adjust this distance slightly). Your left foot should be off the ground and positioned toward the front of your body, with your left leg relatively straight.

Then, bend your right leg at the knee while maintaining your upper body in a relatively vertical position and nearly directly over your right foot. As you bend your right leg, move your left toes toward the wall until they touch, keeping the left leg relatively straight. End the movement by returning to the starting position. Then, conduct essentially the same motion, but move your left foot forward and to the left, again keeping your left leg straight and attempting to make contact with the wall. Your left foot may not quite reach the wall, since you are moving in a frontal plane (from right to left) in addition to the straight-ahead, sagittal plane. Return to the starting position, and then carry out essentially the same motion, but with your left foot crossing over the front of your body and going to the right as you attempt to touch the wall. Then return to the starting position. Do a few (4-6) reps (the straight, left, and right motions make one rep) on your right foot, and then attempt the same exercise with your body weight supported only on the left foot. Like the Eccentric Knee Squat, the Balance and Eccentric Reach with Toes forces your calf muscles to work eccentrically and in a variety of planes of motion, as they do during the stance phase of running (you will really feel it!). Both exertions also do a nice job of strengthening your knee and hip muscles and coordinating their activities with what is happening down at the Achilles and calves.

The Balance and Eccentric Reach with Knee

Stand on your right foot about an arm’s length from the wall, with your left leg flexed at the knee and your left shin roughly parallel to the floor. You should be standing with erect posture, and you may place a finger from each hand on the wall for balance. Then, simply bring your left knee forward until it touches the wall - while moving your upper body backward from the hips so that it remains roughly over the right foot. You will feel a very fine strain in your right calf and Achilles-tendon region. Finish the movement by returning to the starting position. Again, thrust the left knee forward to the wall, but this time move the knee in a frontal plane (towards the left). Return to the starting position, and then move the knee well towards the right. Finish by going back to the starting position. Continue this pattern (straight, left, and right) a few more times, and then change over to the other foot. As you move your knee to the left and right and back to the starting posture, you’ll notice that your activity is forcing the calf muscles and Achilles to withstand ankle-twisting rotational forces and side-to-side (frontal-plane) movements, not just straight-ahead pulling. That’s what you want, because improved strength in all appropriate planes of movement will make you more stable and injury-resistant when you run.

The Dynamic Achilles Stretch

This will actually be the easiest movement to carry out, since it’s somewhat similar to traditional stretching routines for the calf-Achilles complex. Begin this one by facing that familiar wall, about an arm’s length away, with your weight supported on your right foot, your right knee slightly flexed (as it would be during the stance phase of running), your left leg imitating the swing phase of the gait cycle, and your hands against the wall for support. Then, simply rock forward toward the wall, so that you feel a nice stretch in your right calf and Achilles tendon. After 20 seconds or so, pronate your right foot (roll it toward the inside), and hold the stretch for 10 more seconds. Finally, supinate the right foot (roll it toward the outside), and hold for 10 seconds. After you have stretched for a total of about 40 seconds, lean towards the left so that your right Achilles tendon and calf are now being pulled in a lateral-left direction. Hold for 20 to 30 seconds or so. Finally, lean towards the right, crossing your left leg over your right, so that the right Achilles and calf are being pulled in a lateral-right direction. Again, hold for 20 to 30 seconds. Repeat one more time, and then shift over to the left foot for the same pattern of stretching.

5. Footwear

Be aware of the importance of good footwear. A good pair of shoes will help to keep your ankles stable, provide adequate cushioning, and support your foot and lower leg during the running or walking motion.

March 3rd 2019

Swimming

Competitive swimming is primarily an aerobic exercise, involving long exercise time. Muscles must be constantly supplied with oxygen, with the exception of sprints where the muscles are worked anaerobically. Swimming, particularly in events where the stroke styles are varied between backstroke, front crawl (freestyle) and breast stroke, make use of all major muscle groups:

• Abdominals

• Biceps and triceps

• Gluteals

• Hamstrings

• Quadriceps

The basic muscles used for each stroke are: Freestyle; deltoids and legs muscles Breastroke; thighs, biceps, and gluteal muscles Butterfly; abdominals, deltoids and leg muscles Backstroke; Triceps and leg muscles. A single stroke, for example, the butterfly, requires the coordination of various muscles and muscle groups, including:

• Latissimus dorsi

• Posterior deltoids

• Rhomboid muscles

• Middle and lower trapezius

• External and internal obliques

• Transverse abdominis

• Rectus abdominis

• Longissimus

• Spinalis

• Iliocostalis

Hand force applied to the water is actually generated by the rotation of the hips, rather than the muscles of the arm. Torque generated by the larger, stronger hip muscles, allows the swimmer’s powerful arm strokes to strike the water with a rapid turn of the hips. For this reason, elite swimmers focusing on increasing the acceleration of their hips are able to double their peak hand force output.

Most Common Swimming Injuries

• Drowning can result from the inhalation of water, particularly if natural bodies of water swamp or otherwise overwhelm the swimmer

• Exhaustion or unconsciousness may result, especially in open bodies of water

• Swimmers may become incapacitated through shallow water blackout, due to heart attack, carotid sinus syncope (transient loss of consciousness) or stroke

• Secondary drowning can occur should salt water be inhaled, creating a foam in the lungs that restricts breathing, (a condition known as Salt Water Aspiration Syndrome, or SWAS)

• Thermal shock can result from jumping into icy water, which may cause the heart to stop

• An abnormal growth (or exotosis) in the ear can result, due to frequent splashing of water into the ear canal. (Commonly known as Swimmers’ ear)

• Exposure to chemicals, especially chlorine can cause skin irritations while the swallowing of chlorine can adversely affect the lungs

• Chlorine in pools can also damage the hair over time, turning blonde hair greenish and stripping brown hair of its colour

• Various infections can result from swimming as water provides an excellent environment for a variety bacteria, parasites, fungi and viruses

• Skin infections from both swimming and shower rooms are common, particularly, athlete’s foot

• Parasites including cryptosporidium can produce diarrhoea illness should they be swallowed

• Ear infections of the otitis media (or otitis externa) are not uncommon

• Serious health issues may arise from improperly chlorinated pools. These include

illnesses such as chronic bronchitis and asthma

Overuse injuries may result, including back pain, vertebral fractures or shoulder pain, (particularly from excessive butterfly strokes over time). Breaststroke swimmers may develop knee or hip pain, while freestyle and backstroke swimmers risk shoulder pain, (known as swimmer’s shoulder - a form of tendonitis). Osteopathy is essential. Finally, dangers in natural waters place swimmers at risk for a range of accidents and injuries, which include:

• Hypothermia, due to cold water, which can lead to rapid exhaustion and eventual unconsciousness

• Dangerous aquatic life including Stingrays and jellyfish, stinging corals, sea urchins, zebra mussels, sharks, eels, etc.

Injury Prevention Strategies

• Always take time to warm up and stretch, as cold muscles are more prone to injury.

• Avoid swimming alone or in unsupervised areas.

• Properly pace swimming activity avoiding situations of exhaustion, overheating or excessive cold

• Never dive into shallow water, as serious risk exists for disabling neck and back injuries

• Extreme care should be taken in open water. Be certain the water is free of undercurrents, riptides and other hazards

• Avoid swimming in lakes or rivers following a storm, when severe currents may be present

• Use of alcohol should be strictly avoided before swimming, as judgment, orientation and thermal regulation are all impaired with alcohol consumption

• Dry the body thoroughly after swimming and remove excess water from the ear canal to avoid infection

• Attention to proper swimming technique as well as strength and agility training can help avoid common overuse injuries

• Swimmers should be at least minimally knowledgeable about first aid and be prepared to administer it in the case of minor injuries including facial cuts, bruises, minor tendonitis, strains, or sprains

Three Swimming Stretches

1. Reaching-up Shoulder Stretch: Place one hand behind your back and then reach up between your shoulder blades.

2. Arm-up Rotator Stretch: Stand with your arm out and your forearm pointing upwards at 90 degrees. Place a broom stick in your hand and behind your elbow. With your other hand pull the bottom of the broom stick forward.

3. Single Heel-drop Calf Stretch: Stand on a raised object or step. Put the ball of one foot on the edge of the step and keep your leg straight. Let your heel drop towards the ground.

March 2nd 2019

Rugby

Rugby is a game with a good deal of running, and a lot of hard hitting. The minimal, if any, protective equipment worn by players makes it a very violent sport, as well. Because of this, players must be in good physical condition to compete. They must have good cardiovascular conditioning to run the field and must have good musculature to protect their bones and joints. Speed and agility are also important to outrun and out-manoeuvre other players. Rugby players require a strong base, with strong legs and hips. During a rugby scrum the leg and hip drive is important. A strong neck to protect the spine during hits is also important. A strong core is essential for balance and protection of the ribs and internal organs.

Playing rugby taxes all of the muscles, but the major muscles used in play include:

• The muscles of the upper legs and hips; the quadriceps, hamstrings, and the gluteals and the calf muscles; the gastrocnemius and soleus.

• The muscles of the neck and the trapezius.

• The core muscles; the rectus abdominus, obliques, and the spinal erectors.

• The muscles of the shoulder girdle; the deltoids, latissimus dorsi, and the pectorals.

A good strength and conditioning program is important to a rugby player to ensure protection for the bones and joints, and to make the muscles strong enough to continue to play at their optimum level.

Most Common Rugby Injuries

Studies have shown that injuries are the most common reason for players to quit playing rugby. Successive injuries over time can lead to long term effects. Injuries common to rugby include muscle strains, knee sprains, contusions, hip dislocations, and facial injury.

• Muscle Strain: When competing in rugby, or practicing for competition, the muscles are stressed and stretched repeatedly. A hard driving scrum or a move to evade a defender can place the muscles at risk of tearing. When the muscle tears it becomes weaker, pain and tenderness set in, and some slight swelling and bruising may occur. A minor strain will respond to ice, rest, and NSAIDs then osteopathy, with a return to full activity within 1 to 2 weeks. A complete rupture of the muscle will require immobilization, and possible surgical intervention, requiring a much longer recovery time.

• Knee Sprain: Any of the ligaments in the knee are subject to sprain in a hard hitting rugby game. The most common sprains include the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL.) The ACL is often torn when the foot and lower leg are planted but the upper leg rotates. The MCL is commonly sprained by contact from another player on the outside of the knee. The severity of the sprain is determined by the amount of tearing present in the ligament, with the worst being a complete rupture. Minor sprains may take 2 to 3 weeks for recovery, while a complete tear may take 8 weeks. Ice, immobilization, and NSAIDs, then osteopathy will help with recovery.

• Bruises and Contusions: As with any contact sport, bruises and contusions are very common in rugby. Players are being impacted from many directions and the hard hitting results in blood vessels under the skin rupturing and causing swelling, pain, discoloration, and tenderness. Most contusions can be treated with ice and NSAIDs. Deeper contusions in the muscle tissue may require rest and a gradual return to activity as tolerated. Repeated impact with an area that is already bruised may cause damage to the healing tissue, so protection of a contused area is important.

• Hip Dislocation: When the knee and hip are flexed and an impact from behind the knee occurs the hip joint may become dislocated. A direct blow to the hip may also result in a fracture/dislocation of the hip. When the femoral head becomes dislodged from the hip, stability is lost in the hip and the leg is unable to support weight. A hip dislocation is extremely painful and a medical emergency. The hips should be immobilized and the patient transported for medical evaluation. Recovery from a hip dislocation depends on the extent of damage. If the ligaments are torn or a fracture occurs in either hip or femur then the recovery time will be extended. Osteopathy is essential.

• Facial Injury: Facial injuries in rugby can include a broken nose, dislodged teeth, and facial fractures. Due to the lack of a full cage helmet (as used in American Football), the face is exposed to blunt force trauma during hits. This trauma can result in a separation of the cartilage of the nose (broken nose), a tooth being knocked loose, or a fracture to one or more of the bones of the face. Treatment for facial trauma includes removal from the activity, controlling of any bleeding, and ice for swelling and pain control. If a tooth is dislodged the tooth should be retrieved if possible and taken with the player for possible reattachment. Return to activity should only occur after the injury has completely healed, and protective measures should be taken to avoid future injury to that area.

Injury Prevention Strategies

A rugby player must have a lot of natural protective layering (musculature) and be strong enough to withstand the high impact of the game.

• Practicing the game to become proficient at avoiding the hardest hits and knowing how to position the body when delivering a blow, or taking one, will help the player avoid some of the injuries in rugby.

• Playing in official games with referees and officials, under sanctioned rules, will also help to keep the rugby player safe.

• Use of the minimal protective equipment allowed will help shield the body from some of the usual trauma encountered in a game or practice.

• Strength training to build protective muscle tissue over the bones and joints will help keep the body strong for games and speed recovery should an injury occur.

• Flexibility is key when the body is twisted and contorted at different angles during tackles or when avoiding a defender.

Three Rugby Stretches

1.  Reaching-up Shoulder Stretch: Place one hand behind your back and then reach up between your shoulder blades.

2.  Lying Knee Roll-over Stretch: While lying on your back, bend your knees and let them fall to one side. Keep your arms out to the side and let your back and hips rotate with your knees.

3.  Kneeling Quad Stretch: Kneel on one foot and the other knee. If needed, hold on to something to keep your balance and then push your hips forward.

March 1st 2019

Gymnastics

A balance between upper and lower body strength is important for the well rounded gymnast. The legs must be strong to jump and flip, and provide a solid base for the beam and other activities. The upper body must be strong enough to support the body during flips and rolls, and lift the body during bars, vaults, and rings activities.

Gymnastics use the following major muscles during the various events:

  • The upper torso; the deltoids, pectorals, rhomboids, and latissimus dorsi.
  • The core muscles; rectus abdominus and spinal erectors.
  • The hip muscles; the gluteus maximus, hip flexors, adductors and abductors.
  • The muscles of the legs; the quadriceps, hamstrings and the calf muscles.
  • The muscles of the arms; the biceps, triceps and the flexor and extensor muscles of the forearm.

It is important for a gymnast to follow a good strengthening and stretching program for these muscles to keep them ready for competition and practice.

Most Common Gymnastics Injuries

The most common injuries experienced by the gymnast are dislocations, ankle sprains, plantar fasciitis, joint pain, and muscle strains.

  • Dislocations: Dislocations in a gymnast often occur from a bad landing or a fall when the arm is extended. Shoulders are the most common dislocation, with elbows and wrists next, and knees occasionally. A dislocation happens when the bone in a joint is either pushed or pulled out of the normal range of motion and separates from the joint. It may return to normal on its own or it may require medical attention to reduce it. Treatment for a dislocation includes immobilization, ice, rest, NSAIDs and osteopathy. Recovery time for a dislocation depends on the involvement of the ligaments, tendons and bones of the joint and how much total damage occurred.
  • Ankle Sprains: An ankle sprain happens when the joint is rotated through an extended range of motion, causing tears to the ligaments that support the joint. It can occur from rolling of the joint, either in or out. Jumping and running put the ankles at risk of sprains. Landing from a dismount or other activity can easily result in an ankle sprain. Common treatments for ankle sprains include rest, ice, immobilization and osteopathy. Time to full recovery may be as long as 8 weeks depending on the amount of damage done to the ligaments.
  • Plantar Fasciitis: The plantar fascia is subjected to a lot of stress during gymnastics floor moves and during the landing of a dismount. The plantar fascia is a strong ligamentous band that runs along the bottom of the foot and supports the arch of the foot. This band can become inflamed when it is under constant, excessive stress. This inflammation usually occurs at the heel end of the fascia. Rest, anti-inflammatory medication and osteopathy are the best treatment for this injury.
  • Joint Pain: Gymnasts are constantly pounding their joints during jumps, tumbles, flips, and other activities. The cartilage in the joints helps cushion some of the impact; however it can only do so much. The joints, and the bones of the joints, can become inflamed and cause pain. This pain is usually the body’s first warning sign that it is time to take a little rest. With rest and NSAIDs the pain will usually subside. If it does not then there may be another, underlying, problem that must be addressed with osteopathy.
  • Muscle Strains: Muscle strains are common in gymnastics. The muscles must contract forcefully to push the body through the movements of a routine. This forceful contraction may result in excessive tearing of the muscle, a muscle strain. This causes inflammation and pain in the muscle. The tears may be minor, with tears in a small number of fibres, to major, that involve large numbers of fibres and a larger area of the muscle. Treatment usually includes rest, ice, and anti-inflammatory medication. Osteopathy may be beneficial for muscle strains, and stretching and strengthening exercises, may help speed healing.

Injury Prevention Strategies

A gymnast must be conditioned to ensure injury prevention.

  • Practicing the form of each new move to ensure proper form and correct body position will help reduce injuries.
  • Learning the proper form of each new move before trying it; and then practicing it to perfect it will help ensure proper form.
  • The use of spotters when learning a new skill will also reduce the number of injuries.
  • The use of well maintained equipment and a safe practice area is essential in injury prevention.
  • A strengthening and stretching program that covers the entire body, making sure the body is strong and flexible enough to perform the various moves will help the gymnast reach peak levels and avoid injury.

Three Gymnastics Stretches

  1. Arm-up Rotator Stretch: Stand with your arm out and your forearm pointing upwards at 90 degrees. Place a broom stick in your hand and behind your elbow. With your other hand pull the bottom of the broom stick forward.
  2. Standing High-leg Bent Knee Hamstring Stretch: Stand with one foot raised onto a table. Keep your leg bent and lean your chest into your bent knee.
  3. Squatting Leg-out Adductor Stretch: Stand with your feet wide apart. Keep one leg straight and your toes pointing forward while bending the other leg and turning your toes out to the side. Lower your groin towards the ground and rest your hands on your bent knee or the ground.
February 28th 2019

Basketball

Basketball involves muscles throughout the body. Running, pivoting and jumping employ a full range of muscles in the feet, legs and trunk, with particular concentration in the quadriceps and hamstring muscles. The vertical jump in basketball is critical and involves a range of muscles, particularly:

• Abdominals: These muscles are flexible, supporting the back through a range of motion. In particular, the abdominal muscles on the sides, which assist in turning and twisting, known as the obliques, work the hardest, especially in the execution of the jump shot.

• Calf muscles: Located at the back of the lower leg, these muscles are used intensively to achieve vertical height when jumping.

• Hamstrings: These powerful muscles run along the back of the thigh, from the lower pelvis to the back of the shin bone. Hamstrings function to extend the hip joint and flex the knee joint.

• Quadriceps: Located in the knee, the large thigh muscles known as quadriceps muscles are connected to the patella (kneecap) by the quadriceps tendon, while a separate tendon - the infrapatellar tendon - connects the patella to the top of the tibia (shin bone). Quadriceps are a focus of training for basketball players, especially for in order to improve jumping capacity.

• Gluteus Muscles: Known as glutes, these muscles, are responsible for a large portion of the upward thrust necessary in the vertical jump. The gluteus maximus originates along the crests of the pelvic bone crests and attaches to the rear of the femur. Its primary function is hip extension (as the thigh moves to the rear).

As a strong vertical jump gives the athlete considerable advantage in scoring, all five of these muscle groups should be equally targeted in basketball training.

During the free throw in basketball, numerous upper body muscles are employed, including rotator cuff muscles, deltiods, coracobrachialis, latissimus dorsi, pectoralis major, biceps brachii, brachialis, brachioradialis, triceps brachii, anconeus, pronator teres, and pronator quadratus.

A multitude of muscles in the hands and fingers come into play, including the flexor capri radialis, palmaris longus, flexor carpi ulnaris, extensor carpi ulnaris, extensor carpi radialis brevis, extensor carpi radialis longus, flexor digitorium superficialis, flexor digitorum profoundus, flexor pollicus longus, extensor digitorum, extensor indicis, extensor digiti minimi, extensor pollicus longus, extensor pollicus brevis, and the abductor pollicus longus.

Most Common Basketball Injuries

Like many athletic injuries, those occurring in basketball may be classified as overuse injuries and traumatic injuries.

Overuse injuries

Overuse injuries occur when a particular area is put under continual stress and becomes damaged in the process, causing pain, loss of movement, in many cases, swelling. One such injury common to the sport is patellar tendonitis, also known as “jumper’s knee,” which is characterized by pain in the tendon just below the kneecap.

Another typical overuse injury is Achilles tendonitis, involving the tendon connecting the muscles in the back of the calf to the heel bone. The result of this injury is pain in the back of the leg, slightly above the heel. In more severe cases, the Achilles tendon can tear, requiring osteopathy and immobilization of the injury to allow healing.

Shoulder injuries involving overuse are not uncommon and may involve the tendons in their shoulders. The rotator cuff of the shoulder is made up of four muscles, attached by tendons to the shoulder bones. Inflammation and pain can result from overhead activities, including throwing the basketball.

Traumatic injuries

Unlike repetitive or overuse injuries, traumatic injuries result from a sudden forceful event. Among the most common traumatic injuries in basketball are jammed fingers, which can range in severity from minor injury of the ligaments, to a fractured bone. Such injuries require adequate care and may need to be splinted to ensure proper healing. Muscle pulls or tears are common basketball injuries, often occurring in the large muscles of the legs.

• Ankle sprains may be the most frequent basketball injury, often occurring when one player lands on another’s foot or during a rapid change of direction. The result causes the stretching or tearing of the ligaments connecting bones and supporting the ankle. Ligaments tearing may be partial or complete.

• Knee injuries Knee injuries are potentially dangerous and debilitating. The knee may be sprained, with a tearing of ligaments or joint capsule. Twisting the knee can tear the meniscus - tissue acting as a cushion between the bones of the upper and lower leg at the knee. This injury may require surgical treatment.

Tears to ligaments supporting the knee may also be serious. A tear of the anterior cruciate ligament (ACL) is one of the more common ligament injuries. Tears in the ACL require prompt osteopathy and may require surgery.

Injury Prevention Strategies

• Proper warm-up is essential. Jumping jacks, stationary cycling or running or walking helps limber up muscles, preventing strains and other injuries.

• Be aware of the position of other players on the court, to avoid collisions.

• Proper, snug-fitting and supportive footwear can help avoid injuries. Cotton socks absorb perspiration, also providing extra support to the foot. Use of ankle supports can reduce the incidence of ankle sprains.

• Use of a mouth guard helps protect the teeth and mouth.

• Safety glasses should be used by those wearing eyeglasses.

• Basketball courts, whether indoors or out must be free of obstructions and debris

Further, players should be knowledgeable about first aid methods and familiar with first aid options for minor injuries including strains or sprains, facial cuts, bruises, or minor tendonitis.

Three Basketball Stretches

1. Standing Reach-up Quad Stretch: Stand upright and take one small step forwards. Reach up with both hands, push your hips forwards, lean back and then lean away from your back leg.

2. Rotating Stomach Stretch: Lie face down and bring your hands close to your shoulders. Keep your hips on the ground, look forward and rise up by straightening your arms. The slowly bend one arm and rotate that shoulder towards the ground.

3. Single Heel-drop Achilles Stretch: Stand on a raised object or step and place the ball of one foot on the edge of the step. Bend your knee slightly and let your heel drop towards the ground.

February 27th 2019

Badminton

Most people can easily learn to hit the shuttlecock over the net. However, at the competitive levels a great deal of cardiovascular conditioning and muscular endurance are needed. Great agility, quickness, and reaction are essential to be successful in badminton as well. Lower body strength and endurance are important to the badminton player. A strong swing requires good upper body strength, as well. Core strength and endurance help with balance which improves overall agility.

Playing badminton requires the use of the following major muscles:

• The muscles of the lower leg; the gastrocnemius, the soleus and the anterior tibialis.

• The muscles of the upper legs and hips; the gluteals, the hamstrings, and the quadriceps.

• The muscles of the hip; the gluteals, the adductors and abductors, and the hip flexor.

• The muscles of the shoulder girdle; the latissimus dorsi, the teres major, the pectorals, and the deltoids.

• The core muscles; the rectus abdominus, obliques, and the spinal erectors.

• The muscles of the forearm and upper arm; the wrist flexors and extensors, the biceps and the triceps.

A conditioning program that includes an overall cardiovascular program, a solid strength component, and good flexibility training will keep the badminton player healthy and performing at his or her peak.

Most Common Badminton Injuries

Badminton is not a contact sport, but due to the fast pace it can result in traumatic injury. Ankle sprains, Achilles tendon strains, anterior cruciate ligament sprains, and rotator cuff injuries are all common among competitive badminton players.

• Ankle Sprains: The sudden change in direction, especially once a player becomes fatigued, can easily result in the ankle “rolling.” This rolling of the ankle causes tears in the ligaments that support the ankle. This results in pain and tenderness at the injury site, swelling, and difficulty bearing weight. A popping sensation may be felt with the injury, as well. Initially ice, immobilization, and compression may help reduce the discomfort, followed by osteopathy. An x-ray should be taken to rule out a fracture. Usual recovery time is about 4 to 6 weeks for a moderate sprain.

• Achilles Tendon Strain: The Achilles tendon connects the calf muscles to the heel bone (calcaneus.) When the calf muscle contracts forcefully this tendon is under a great deal of stress. If the muscle is tight or not properly warmed up, a tear may occur in the tendon. This is called a strain. The amount of the tendon involved in the tear will determine the severity of the injury. A complete tear (or rupture) will take much longer to heal and may require surgical intervention. Minor tears can be treated with osteopathy, rest, ice and NSAIDs. The low blood flow to tendons complicates the recovery and lengthens the process.

• Anterior Cruciate Ligament (ACL) Sprain: The anterior cruciate ligament is the main stabilizing ligament in the knee. When the foot is planted and the upper leg begins to rotate the ACL is put under tremendous stretch, and may result in a tear. This reduces the structural integrity of the knee and results in a great deal of pain. Immobilization, ice, and rest are keys to treating an ACL injury. In cases of complete rupture of the ligament, surgical intervention may be needed to reattach the ligament. This, of course, increases overall recovery time. The knee may be loose and lose some structural strength, requiring both osteopathy and exercises to get it back to pre-injury condition.

• Rotator Cuff Injuries: The swinging motion places the shoulder in an exposed position and if the arm rotates out of the natural path of movement the shoulder may be injured. The rotator cuff muscles are designed to stabilize the shoulder and if they are stretched or torn due to an acute, unnatural movement, they will not be able to provide that support. Acute injury to the rotator cuff can be minor, a simple strain of the muscles, to severe, with a complete rupture of the muscular structure. Chronic injury to the rotator cuff muscles and tendons may also occur if improper body mechanics are used in the swing repetitively. Rest, ice and NSAIDs is needed for acute conditions, while osteopathy will be needed to help heal both acute and chronic injuries.

Injury Prevention Strategies

Overall conditioning is essential to the badminton player to help reduce injuries on the court.

• Playing on well-manicured outdoor courts or indoor courts with well-maintained surfaces will reduce lower extremity injuries.

• Strong muscles, especially in the lower extremities, will prevent many injuries caused by the constant change in direction and explosive movements.

• Good endurance will help delay the onset of fatigue, which contributes to a high percentage of sports injuries.

• Quality equipment and body mechanics training will help prevent chronic injuries that develop due to misalignment issues.

• Proper warm-up and a good flexibility program will reduce injuries from tight and inflexible muscles.

Three Badminton Stretches

1. Rotating Wrist Stretch: Place one arm straight out in front and parallel to the ground. Rotate your wrist down and outwards and then use your other hand to further rotate your hand upwards.

2. Elbow-out Rotator Stretch: Stand with your hand behind the middle of your back and your elbow pointing out. Reach over with your other hand and gently pull your elbow forward.

3. Standing Toe-up Achilles Stretch: Stand upright and place the ball of your foot onto a step or raised object. Bend your knee and lean forward.

February 26th 2019

ACC

You don’t need to have a GP referral to see an osteopath on ACC. Philip can help you can make a new ACC claim if you have an injury that is the result of an accident which happened within the last year. ACC contributes to the cost of osteopathic treatment of everyone, of any age, both working and not working, for all injuries that result from an accident that occurred at work, at home, playing sports or driving. The accident must involve an external force or resistance. This can include road traffic accidents, sports injuries, carrying something, lifting, pushing or pulling something, or falling and hitting something or something hitting you. ACC does not cover bending or twisting if no external force or resistance is involved, even if the injury occurred at work. ACC does not fully fund osteopathy, so a top-up payment is payable by the patient. You must start your osteopathic treatment within one year of the accident date, and can initially have up to 16 treatments within 52 weeks of your accident date. In some circumstances it may be possible to make an ACC32 application for additional treatments. If you have not seen Philip recently you will need to have a consultation so Philip can get current information to complete the application. Any additional treatments approved must be given by the osteopath who makes the application. For a standard ACC32 request, there is no application fee. Standard requests must meet the following criteria.

• it’s for an accepted ACC claim

• you are within 12 months of the injury

• this is the first additional treatment request for the claim

• it’s for the original diagnosis and listed on the standard Read Code list

 A non-standard request is a long and complicated procedure, and there is a fee of $30. Non- standard requests are often declined. If ACC declines your claim, declines your application for additional treatment, or declines to pay for treatment on an existing claim for any reason, you will then be liable to pay the difference between the ACC top-up payment and the private fee of any osteopath treatments that you have had. If you are making a new ACC claim or applying for additional treatment, you may wish to wait until you have heard from ACC before you have further treatment.

 If your injury is work related, please let your osteopath know whether your employer is an ‘accredited employer’ in the ACC Partnership Programme (these are all large companies). This means that they take responsibility for their employees’ work injury claims. If you don’t know, please ask your employer. If they are, you will need to provide your osteopath with contact details for both treatment approvals and invoicing. Accredited employers (or their insurance companies) usually allow fewer treatments than ACC does, for similar injuries. It is a Worksafe New Zealand (formerly OSH) requirement that if you have an injury at work, that you should complete an incident report at your work place.

ACC will be able to help you with travel expenses if, within 14 days of your injury, you need to travel more than 20 kilometres (one way per trip), or you travel more than 80 kilometres within any calendar month, or within any calendar month you spend more than $46 on bus, train or ferry (or, with prior approval from ACC, you spend more more than $46 within any calendar month for other transport such as taxis, hire-cars or shuttles). ACC will then pay your return fare, provided you return to where you started from. If you use a private vehicle they’ll pay 29 cents per kilometre (inclusive of GST). ACC can help pay the travel costs for someone to travel with you if you qualify for travel costs and you’re under 18 years, or your medical condition requires that you travel with an escort, or the transport provider requires you to have an escort. If you share private transport ACC will pay the private transport rate for one person only. You will need to keep your tickets or receipts and give the form to Philip to stamp and sign. To obtain an ACC250 Request for Travel Costs form call ACC on 0800 101 996 then press 4, drop into your nearest ACC office or simply Google: “ACC250”, and download it. Under New Zealand legislation an osteopath is unable to certify anyone as unable to work. Please see your GP if you need such certification for your employer, ACC or WINZ.

February 25th 2019

If you have an injury: RICE

R = Rest
I = Ice
C = Compression
E = Elevation

You should apply the RICE method in the 24 hours immediately following injury in order to relieve pain and reduce the extent of swelling (inflammation). The RICE method should not be used if you have Raynaud ’s disease, diabetes or peripheral vascular disease.

REST
Stop activity. With an injury to the leg, this may mean having to use crutches.

ICE
Apply ice for 10-15 minutes every 1-2 hours initially and then gradually reduce the frequency of application over the next 24 hours.
Methods of applying ice:
• Ice bucket.
• Instant ice packs.
• Crushed ice wrapped in wet towel.
• Packet of frozen peas wrapped in wet towel.

COMPRESSION
Compression, by the use a compression bandage around the injured area, helps to prevent or reduce swelling. The bandage should be applied firmly but not so tight that the blood is cut off. If applied to a limb, the fingers or toes should remain pink and not become ‘tingly’. Ice can be used over the bandage. Remove the bandage every 3-4 hours and reapply.

ELEVATION
Raise the leg above the level of your hip e.g. lie down with your leg propped up on a chair and/or pillows, or the arm in a sling or with the hand on the opposite shoulder.

February 24th 2019

The Kirksville Declaration

The basic concept of osteopathy was described in the introduction to the Kirksville consensus declaration written in 1953: “Osteopathy is a philosophy, a science and an art. Its philosophy embraces the concept of the unity of the body structure and function in health and disease. Its science includes the chemical, physical and biological sciences related to the maintenance of health and the prevention, cure and alleviation of disease. Its art is the application of the philosophy and the science to the practice of osteopathy. Health is based on the natural capacity of the human organism to resist and combat noxious influences in the environment and to compensate for their effects; to meet, with adequate reserve, the usual stresses of daily life and the occasional severe stresses imposed by extremes of environment and activity. Disease begins when this natural capacity is reduced, or when it is exceeded or overcome by noxious influences. Osteopaths recognise that many factors impair this capacity for resistance and recovery, thus reaffirming the validity of the ancient observation that the physician deals with a patient as well as a disease.”

February 23rd 2019

The Principals of Osteopathy

The following set of principals are based on those offered in 2002 by Felix Rogers DO, Gilbert D'Alonzo Jnr DO, John Glover DO, Irvin Korr PhD, Gerald Osborn DO, Michael Patterson PhD, Michael Seffinger DO, Terrie Taylor DO, and Frank Willard PhD.

1. A person is the product of dynamic interaction between bio, psycho, social and environmental factors.

The human body functions as a unit, with structure and function being reciprocally interrelated between all systems and levels of organisational complexity. Alterations in the structure or function of any one area of the body influences the integrated function of the body as a whole.

2. An inherent property of this dynamic interaction is the capacity of the individual for the maintenance of health and recovery from disease.

Osteopaths view health as the natural state of the body. The health of the individual is determined by complex, self-regulating homeostatic systems that are strongly influenced by the structure of the individual. These regulatory systems are capable of compensatory alterations in the face of disease, yet can be self-healing and restorative when their function is optimised.

3. Many forces, both intrinsic and extrinsic to the person, can challenge this inherent capacity and contribute to the onset of illness.

A realistic view of health focuses on wholeness, understanding and accepting of the person in his or her full ecologic context, and appreciating his or her efforts to maximise health status and cope with disease or disability. Osteopaths recognise that each individual is uniquely vulnerable to stressors that place him or her at risk for loss of health. Illness is thought to represent the body’s inadequate, self-regulatory responses to challenges from the internal and external environment.

4. The neuromusculoskeletal system significantly influences the individual’s ability to restore this inherent capacity and therefore to resist disease processes.

Historically, orthodox medicine has emphasised internal organs and their disturbances; diagnostic and therapeutic methods have been largely directed at the manifestations of these disturbances. The neuromusculoskeletal system has been relegated to a secondary role, as an organ system that is primarily related to locomotion. Osteopaths consider the neuromusculoskeletal system to play a primary role in health and disease. Metabolically, it can be the most demanding body system, and its requirements vary widely and often rapidly from moment to moment according to individual activities and responses to the environment. Derangements in the neuromusculoskeletal system are common and represent significant public health concerns. Abnormalities in the structural system affect its function and that of related circulatory and neural elements. The interventions directed to the neuromusculoskeletal system include osteopathic palpatory diagnosis and manual treatment, therapeutic and recreational exercise, and physical therapy modalities.

5. The patient is the focus for healthcare.

Osteopaths are trained to focus on the individual patient and resist reducing the focus to the abstractions of presenting symptoms, body parts and named disease entities. The relationship between clinician and patient is a partnership in which both parties are actively engaged. The osteopath is an advocate for the patient, supporting his or her efforts to optimise the circumstances to maintain, improve, or restore health and well-being.

6. The patient has the primary responsibility for his or her health.

Although the patient-osteopath relationship is a partnership, and the osteopath as a healthcare professional has obligations to the patient, ultimately the patient has primary responsibility for his or her health. The patient has inherent healing powers and must nurture these through diet and exercise, as well as adherence to appropriate advice in regard to stress, sleep, weight control, and avoidance of substance misuse.

An effective osteopathic treatment program is founded on these principals and:

  • incorporates available evidenced-based and best-practice guidelines as appropriate to the patient’s needs  
  • optimises the patient’s natural healing capacity
  • addresses the primary cause of disease
  • emphasises health maintenance and disease prevention

The emphasis on the neuromusculoskeletal system as an integral part of patient care is one of the defining characteristics of osteopathy. When applied as part of a coherent philosophy of the practice, these principals represent a distinct and necessary approach to healthcare.  

February 22nd 2019

Archery


Archery does not require a great deal of cardiovascular conditioning, but it does require muscular endurance. The continuous drawing back of the bow string requires strength and endurance in the upper body. A strong core and lower body is essential for balance and control. Strong forearms will ensure proper aiming and a steady grip. The major muscles used by the archer include:

• The muscles of the shoulder girdle; the latissimus dorsi, the teres major, and the deltoids.

• The muscles of the neck; the levator scapula and trapezius muscles.

• The core muscles; the rectus abdominus, obliques, and the spinal erectors. 


• The muscles of the upper legs and hips; the gluteals, the hamstrings, and the quadriceps. 


A good overall strengthening program to keep the muscles strong and flexible will keep the archer on target for a long time. 

Most Common Archery Injuries 

Archery is a non contact sport that does not subject the body to a lot of violent impact. With the exception of an errant bolt, there are very few dangers of traumatic injury for the archer. The repetitive motion involved in practice and competition does, however, put the archer at risk for repetitive strain injuries. Although archery has a low reported incidence of injury associated with it, there is some risk. The archer may fall victim to rotator cuff injuries, tendonitis in the elbow, wrist, or shoulder, contusions, and impalement (although very rare.)

• Rotator Cuff Injuries: Due to the constant draw on the bow string, especially at high draw weights, the rotator cuff muscles are under constant strain. The action of holding the string back as the arrow is sited puts additional stress on these muscles. The muscles may become fatigued leading to the potential for strains. Pain in the shoulder, especially during the drawing action may be evident. Weakness and inability to lift and rotate the arm may also occur. This may be treated with osteopathy, rest, ice and the use on non-steroidal anti-inflammatory medication. In severe cases, or complete tears or resistance to treatment, surgical remediation may be required.

• Tendonitis: Tendonitis is caused by unusual or repetitive strain on the tendon. The constant strain placed on the tendons during archery can lead to tendonitis in the joints of the upper extremities, specifically the wrist, elbow, and shoulder. Pain in the attachment of the muscle, especially when the muscle flexes before warming up, may indicate tendonitis. The joint may be stiff and sore and the muscles may be weaker than usual. Osteopathy, rest and NSAIDs may be all that is required to treat tendonitis. Recovery time will vary depending on the severity of the condition, with an average three to six weeks.


• Muscle Strains: The muscles of the back, neck and shoulder are subjected to constant tension during archery and overtime, or when using a different bow, could be subject to a strain. The muscle fibres tear slightly during normal use, but when subjected to a load that is greater than their capacity more fibres may tear, causing pain and inflammation. The muscle will also be unable to handle large loads until it repairs. Pain within the muscle, inflammation, and stiffness may be evident with a strain. Osteopathy, rest, ice (for the first 72 hours), and anti-inflammatory medication will help manage the strain. Limited activity can be attempted as it is tolerated.

• Contusion: When the bow string is released it may slap along the forearm on the way back, this is called “String Slap.” This can cause bruising where the string hits. The blood vessels under the string are broken due to the force of the string hitting the area and this causing bleeding under the skin. Slight swelling and discoloration will be present. Sharp pain will be felt immediately, then the pain becomes dull and usually only occurs with pressure on the area. Ice and protection will speed the recovery of the contusion.

Injury Prevention Strategies

• The use of proper equipment and an overall conditioning program to prepare the muscles for repetitive use is essential for the archer.

• Proper use of arm guards and release devices will prevent “String Slap” and other potential injuries.

• Gradual increases in draw weight and repetitions during practice will ensure that the body is ready for the next step without shocking the muscles, helping to prevent strains.

• A good strengthening program for the upper body will prepare the muscles for the repetitive strain of drawing back the string and holding the position.

• Flexibility is essential to aid in recovery and keeps the muscles ready each time they are called into play. A good overall stretching routine will also help prevent imbalances caused by constantly pulling the same way.

Three Archery Stretches

1. Arm-up Rotator Stretch: Stand with your arm out and your forearm pointing upwards at 90 degrees. Place a broom stick in your hand and behind your elbow. With your other hand pull the bottom of the broom stick forward.

2. Rotating Stomach Stretch: Lie face down and bring your hands close to your shoulders. Keep your hips on the ground, look forward and rise up by straightening your arms. The slowly bend one arm and rotate that shoulder towards the ground.

3. Assisted Reverse Chest Stretch: Stand upright with your back towards a table or bench and place your hands on the edge. Bend your arms and slowly lower your entire body. 

February 3rd 2019

Osteopathy in the Rest of the World

Dr John Martin Littlejohn, a Scotsman, was the first professor of physiology at the ASO and also dean of the ASO. He established the Chicago College of Osteopathy in 1900. Teaching in theoretical subjects was extended and physiology was established as a central subject. The school flourished and developed into one of the most important scientific sources of early osteopathy. In 1913 Littlejohn returned to the UK and and in 1917 established the British School of Osteopathy where he taught until he passed away in 1947. He developed a theory of spinal mechanics, published many papers, and wrote two textbooks.

Until the 1960’s, all osteopathy schools worldwide taught osteopathic diagnosis based primarily on structural alignment and theories of spinal mechanics formulated by pioneers such as Littlejohn and Fryette. In the 1960’s Hugh Middleton of the BSO started a new approach based primarily on assessing the function of all joints and tissues of the musculo-skeletal system and correcting any dysfunction. Normal mechanical function leads to normal physiology and hence helps eliminate pathology (disease). It also became standard practice to identify the tissues causing symptoms, the pathology of those tissues, the pre-disposing factors, precipitating factors and maintaining factors. These factors include not only neurological, muscular and skeletal factors, but also the patients home, work and social environment, psychology, old injuries etc. This more holistic approach is very effective and is also more acceptable to regulators and other health professionals. In the 1970’s Laurie Hartman of the BSO developed a way of performing high velocity thrust manipulations with minimal leverages. Since the 1980’s he has taught his techniques and the functional approach to other UK osteopathic colleges. These are now taught at all British, New Zealand and Australian schools of osteopathy except for one small UK school.

Over time more osteopathic schools were started in the UK, Australia and New Zealand, and more recently in other countries. Osteopathy courses in New Zealand, Australia and the UK are rigorously science based and teach a non-surgical, non-pharmaceutical approach based on the updated principals of osteopathy. Their graduates are primary care practitioners who see themselves as manual medicine or neuromusculoskeletal (NMS) specialists, complementary to all systems of medicine. They spend considerably more time training in osteopathic diagnosis and technique than their US counterparts, in addition to the study of anatomy, physiology, pathology, embryology, neurology, paediatrics, orthopaedics, rheumatology and psychology to a similar standard as medical schools. Some medical doctors undertake a postgraduate training in osteopathy.

Courses in osteopathy are currently offered by ten universities and colleges in Britain, eight in Canada, seven in France, five in Germany, three in Belgium, Russia, Spain and Australia (RMIT, Victoria University and Southern Cross University) and two in Finland, the Netherlands, Switzerland, Argentina, Austria, Chile, Ireland, Italy, Norway, Poland, Sweden, South Korea and New Zealand (one at UNITEC in Auckland which has stopped taking new students, and a new course that started at the ARA institute in Christchurch in 2018). The qualifications conferred vary widely, and include: certificates, diplomas, bachelors’ degrees, masters’ degrees and Doctor of Philosophy (PhD).

February 2nd 2019

Osteopathy in the USA after Still

In the early 20th century, osteopathy in the United States moved closer to mainstream medicine. The first state to pass laws giving those with a D.O. degree the same legal privilege to practice medicine as those with an M.D. degree was California in 1901, the last was Nebraska in 1989. In 1962, in California, the AMA tried to eliminate the practice of osteopathic medicine in the state. In 1974, the California Supreme Court ruled that licensing of DOs in that state must be resumed, and as of 2012, there were 6,368 D.O.s practicing in California. Osteopathic physicians are licensed to perform surgery and prescribe medications, and are taught to practice medicine with a patient-centered, holistic approach, emphasising the role of the primary care physician within the health care system plus osteopathic manipulative therapy (OMT) as an adjunctive measure to other biomedical interventions for a number of disorders and diseases. There are currently 29 osteopathic medical schools in the United States, offering education at 37 locations. As of 2011, there are approximately 78,000 osteopathic physicians in the U.S., but only about 2,000 of those practice OMT as their sole modality. (90% of manipulative therapy in the US is administered by chiropractors, of which there are 49,000). A 2001 survey of osteopathic physicians found that more than 50% of the respondents used OMT on less than 5% of their patients. The survey indicates that osteopathic physicians have become more like M.D. physicians in every respect —few perform OMT, and most prescribe drugs or suggest surgery as a first line of treatment. Osteopathic physicians are unevenly distributed in the United States. The states with the highest concentration are Oklahoma, Iowa, and Michigan where osteopathic physicians comprise 17-20% of physicians, and the lowest concentrations of DO’s are Louisiana, Massachusetts and Vermont where only 1–3% of physicians have an osteopathic medical degree. Public awareness of osteopathic medicine likewise varies widely in different regions. U.S. trained DOs are currently able to practice in 45 countries with full medical rights, including New Zealand and the United Kingdom, but not in Australia or the Republic of Ireland. The United States does not have any colleges training non-physician osteopaths, and osteopaths trained in other countries are not permitted to practice in the U.S.

February 1st 2019

Some of the Major Influences on Andrew Taylor Still

Still was influenced by the intellectual and philosophical movements making their way across America during his life time such as transcendentalism, phrenology, natural hygiene, homoeopathy, magnetic healing, spiritualism and mesmerism and also by Hippocrates’s doctrine where all illness was seen as the result of an imbalance in the body of four humours. The therapeutic approach was based on “the healing power of nature” (“vis medicatrix naturae”), the body containing within itself the power to rebalance the four humours and heal itself. He studied the English philosopher Herbert Spencer, who developed a theory of evolution before Darwin and wrote about a wide range of subjects, including ethics, religion, anthropology, economics, political theory, philosophy, biology, sociology, and psychology. In later years Still was a Freemason.

Still, was fascinated with machines, and was an amateur inventor. He assembled and operated a steam-powered saw mill when he helped build Baker University. He invented a wheat harvesting machine, but his idea was stolen by a visiting sales representative, who put it into production. In 1871 he invented and marketed a centrifugal butter churn. Some of his inventions were related to the practice of osteopathy, such as the patient brace, a simple device designed to keep patients from falling off the narrow treatment table during vigorous manipulations. In 1910 he patented a smokeless coal furnace, though he had difficulty producing a full-sized working model. Heartbroken by Mary Elvira’s death in May 1910 he did not pursue the matter further. He was fascinated by human mechanics and had an excellent knowledge of anatomy. Still said: “An osteopath is only a human engineer, who should understand all the laws governing his engine and thereby master disease.” Still, as a boy, scrutinised the muscles, nerves and bones of the animals he hunted. Later, as a young doctor he dug up Indian graves to study the skeletons. For years he carried one or two bones in each of his pockets and often a whole sackful over his shoulder. He wondered about their mechanics and how they influenced health and disease. He saw that the nerves that control the body branched off from the spinal column through small holes between the vertebrae. He became convinced the minor dislocations or subluxations, which he called “osteopathic lesions” could cause disease. He said: “all diseases are mere effects, the cause being a partial or complete failure of the nerves to properly conduct the fluids of life”.

Still was an intuitive thinker who spoke in florid allegories, was dogmatic, evangelical, kind, humorous and generous. He was venerated by his early followers as an infallible font of truth. He continued to dress as a ‘tramp doctor’, even as principal of the ASO. Many of his ideas were years ahead of their time. Still never believed that drugs apart from anaesthetics and antiseptics had any value. At the time that Still learned medicine form his father, Louis Pasteur had yet to discover, in 1861, that micro-organisms cause infectious diseases, and it wasn’t until 1865 that Joseph Lister invented anti-sepsis. Common medical treatments at that time included vomiting, purging, blood-letting and heroic doses of opium, morphine, arsenic, and calomel (a mercury based drug which rotted the teeth, gums, and cheeks of the patient), and often did more harm than good and didn’t prevent three of his children dying from meningitis. He correctly recognised that the muscular and skeletal systems are important to the body’s health. His belief in the self-healing powers of the body is similar to modern theories. His idea of the “osteopathic lesion” (now called “somatic dysfunction”) has been supported by research by Korr and Denslow on how a facilitated segment can act as a neurological lens contributing to disease. Osteopaths today do not believe that “somatic dysfunction” can be the sole cause of disease, but that it can be a contributing factor, and that treatment of “somatic dysfunction” can be an adjunct to conventional medical treatment to hasten recovery.

January 31st 2019

The Story of Osteopathy Part Seven

On 1st November 1892 Andrew opened the American School of Osteopathy (later renamed the Kirksville College of Osteopathic Medicine, and now part of the AT Still University) in a two roomed timber framed building. Bill Smith taught anatomy and some chemistry and physiology. This first class consisted of five women and sixteen men, including former patients, family friends, three of Andrew’s children and his brother. At the time women were barred from US medical schools. The first graduation was in 1894. Andrew wished his graduates to be general practitioners, caring for patients with a wide variety of health problems, able to perform surgery, and deliver babies. The state of Missouri was willing to grant him a charter for awarding the MD degree, but he remained dissatisfied with the limitations of conventional medicine and instead chose to retain the distinction of the DO degree. An infirmary was opened in January 1896 and in that year Andrew and his students had performed thirty thousand osteopathic treatments. Andrew sanctioned the use of anaesthetics and antiseptics. By the late 1890’s his school, infirmary and new surgical hospital were increasingly successful both academically and financially. In 1897 two wings were added to the infirmary that more than tripled the size of the original building. The Wabash Railroad Company had to increase the number of passenger trains running to Kirksville to four a day to accommodate the 400 people traveling to the ASO every day for treatment. By 1902 the ASO was graduating 300 students a year. Andrew Taylor Still died on 12th December 1917 from the effects of a stroke he had sustained three years earlier.

January 30th 2019

The Story of Osteopathy Part Six

Andrew had an epiphany on 22nd June 1874 - he saw the body as an intricate machine which if free from displacements, derangements and contractures, nourished and cared for, will perform the functions for which it was intended, having within itself the power to manufacture and prepare all chemicals, materials and forces needed to regain its normal equilibrium and run smoothly to a useful old age. In September 1874 Andrew performed what he later called his first osteopathic treatment (although he wouldn’t call it that until 1885), treating for no fee a poor boy he saw in the street with his lower body covered with blood. In Andrews’ own words: “My first case was of bloody flux (haemorrhagic gastroenteritis) in a little boy of about four summers. I didn’t know what caused the flux, except that it affected young and old alike and was common in summer. I knew that a person had a spinal cord, but really I knew little, if anything, of its use. I had read in anatomy that the upper portion of the body was supplied with motor nerves from the front side of the spinal cord, and that the back side of the cord gave off the sensory nerves, but that gave no very great clue to what to do for flux. I placed my hand on the back of the little fellow, in the region of the lumbar, which was very warm, even hot, while the abdomen was cold. I began work at the base of the brain, and thought by pressure and rubbing I could push some of the hot to the cold places. While so doing I found rigid and loose places in the muscles and ligaments of the whole spine, while the lumbar was in a very congested condition. I worked for a few minutes on that philosophy, and told the mother to report to me the next day, and if I could do anything more for her boy I would cheerfully do so. She came early next morning with the news that her child was well. Flux was in a large percent of the families of Macon. My home at that time was still in Baldwin, Kansas, and I was only visiting in Macon. The lady whose child I had cured brought many people with their sick children to me for treatment. As nearly as I can remember, I had seventeen severe cases of flux in a few days, and cured them all without drugs.”

 Soon after, Andrew was publicly “read out” (or formally removed) from the Methodist Church by the minister in Baldwin, Kansas. Because of his “laying on of hands”, Andrew was accused of trying to emulate Jesus Christ and was labelled an agent of the devil. His practice dropped off rapidly. He was socially and professionally ostracized, became financially destitute, and was ultimately forced to move his family to Macon, Missouri. From that time he called himself a “magnetic healer”. Shortly after he moved alone to Kirksville, Missouri and after three months sent for his family to join him. Kirksville at that time had a population of 6000. In 1876, he was stricken with typhoid and for six months was confined to bed. From 1880 until 1885 Andrew called himself a “Lightning Bone Setter” traveling from town to town in rural Missouri. He used to treat people in the street for all manor of diseases solely using lightening bone setting, and was known as the “tramp doctor”, sleeping wherever he could find a bed. He was away from his wife and children for months at a time. In 1885, on the advice of his friend, the Scottish doctor William (Bob) Smith, Andrew changed the name of his healing art from lightening bone setter to osteopathy, from the Greek “osteon” for bone and “pathos” for suffering. In 1886 Bob Smith helped Andrew set up his first clinic in Kirksville and Andrew stopped travelling. Andrew continued to refine osteopathy. He described the principals of osteopathy as: structure governs function, the medicine chest within, the rule of the artery reigns supreme and the body is a unit. Although he and others doubted whether osteopathy could be taught, he made several attempts to train others. Andrew hoped that his two sons would carry on his work through the establishment of a school of osteopathy, so he waited for their return from service in the army. During this time patients flocked from all over America for his treatment. Hotels were built in the town of Kirksville to house the many patients who arrived daily for help.

January 29th 2019

The Story of Osteopathy Part Five

After he returned from the war, Andrew and his wife Mary Elvira repeatedly petitioned the US government for Andrew to receive a pension based upon the injury (the hernia) he received in the Civil War, which made him unable to do hard physical work, such as farming. However, because the Kansas Militia was not officially sworn in to the Union Army, their requests were denied. Andrews earnings were very low, and the family suffered many hardships. Andrews’ faith in medicine was shaken when, within two weeks, three of his children from his first marriage died of meningitis, and two weeks later a child from his second marriage died of pneumonia. Andrew with his medical knowledge could do nothing to help them. In 1867 Abram died at age 71 of pneumonia. Andrew was very close to his father and his death was a great loss. Three children were then born in close succession. In 1870 Andrew enrolled for a short course in medicine at the College of Physicians and Surgeons in Kansas City, though there is no record of his graduation. Some believe that he had extensive arguments with the faculty and dropped out. In 1873 Andrew was seriously ill with a lung infection for three months. After his recovery another child was born.

January 28th 2019

The Story of Osteopathy Part Four

From 1861-1864 Andrew fought in the Civil War on the side of the Union Army. He served his entire military career in Kansas, in several different militia units. Andrew was refused a commission as a surgeon due to his lack of formal training, so he enlisted as a hospital steward with the rank of sergeant. Normally hospital stewards were selected for training from the enlisted men in the hospital corps. They were given a basic training in sanitation, pharmacy, medicine and surgery and their duties included being in charge of hospital stores, dispensing medicines and having general charge of the sick in the absence of the medical officers. Andrew was exempt from this training because of his prior medical training from his father, and his medical experience. A hospital steward could expect to be promoted to an officer and surgeon with experience. Andrew stated in his autobiography that whilst he was nominally a hospital steward was in reality a de-facto surgeon. After his first militia unit was disbanded Andrew wished to be an infantry officer. He organised a new militia, was promoted to the rank of Captain and ultimately achieved the rank of Major. Andrew fought in the Battle of Westport, during which he suffered an inguinal hernia.

January 27th 2019

The Story of Osteopathy Part Three

Andrew was active in the abolition movement and a friend of the anti-slavery leaders John Brown and James H. Lane. He became deeply involved in the fight over whether Kansas would be admitted to the Union as a slave state or a free state. The Kansas–Nebraska Act of 1854 provided that the settlers in those two territories would decide the question for themselves. Civil war raged in Kansas as both sides tried to gain control of the territorial government. In October 1857, Andrew was elected to represent Douglas and Johnson counties in the Kansas territorial legislature. Andrew and his brothers took up arms in the cause and participated in the Bleeding Kansas battles (between the pro and anti-slavery citizens). By August 1858, a free-state constitution had been passed; Kansas was admitted to the Union as a free state on January 29, 1861. Andrew would serve a total of five years in the Kansas legislature. Andrew and his family were among the founders of Baker University, the first 4-year university in the state of Kansas. Abram was a commissioner, Andrew and two brothers donated land and helped build the university. The university later refused to let Andrew present his ideas about osteopathy, which he found hurtful. In 1859 Mary Margaret died two months after giving birth. The baby had lived only five days. She had previously lost another child in infancy. She left Andrew with four children. In 1860, Andrew married his second wife, Mary Elvira Turner. They were together until she passed away 50 years later.

January 26th 2019

The Story of Osteopathy Part Two

When he was 18 Andrew wanted to enlist in the army to fight in the war between the United States and Mexico, but Abram refused to let him go, saying that he was too young. In 1849 Andrew married Mary Margaret Vaughn. Andrew’s primary occupation was farming. He ploughed 60 acres of land and planted corn. On 4th July 1849 a hail storm destroyed the crop. It was a disaster and the family was financially decimated. Andrew taught at the local school that autumn and winter for $15 per month and began to study medicine with his father. Andrew and Mary’s first children are born in 1849 and 1852. In 1851 Abram was posted to run the Wakarusa Shawnee Mission in the Kansas territory. Part of the reason for the posting was to get him out of Missouri, a pro-slavery state where Abram’s strong anti-slavery sermons were getting an increasingly hostile reception. Andrew and his brothers helped Abram with the family farm, whilst Andrew also helped him with his preaching, teaching and doctoring. Andrew and his family was to live in Kansas for the next 22 years. In 1853 Andrew served in John Fremont’s expedition that set off from Kansas City to find a central route for the transcontinental railroad, through Colorado, Utah and Nevada to California, crossing the Rocky Mountains. Bad weather in Utah forced the expedition to turn back.

January 25th 2019

The Story of Osteopathy Part One

Andrew Taylor Still was born in Lee County, Virginia on 6th August 1828, the third of nine children born to Abram and Martha Still. Abram was an itinerant Methodist preacher, farmer and doctor. Six years later, Abram moved the family to Tennessee to accept the position of a circuit preacher and in 1837 they moved to Missouri, a journey of over 700 miles, taking 7 weeks with 6 children in two covered wagons and six horses. At the age of ten, Andrew suffered from frequent headaches with nausea. He constructed a rope swing between two trees, eight to ten inches off the ground. He lay down using the rope for a swinging pillow. He wrote, “I lay stretched on my back, with my neck across the rope. Soon I became easy and went to sleep, got up in a little while with headache all gone.” He later quipped that this was the first osteopathic treatment. He continued to use this ‘treatment’ successfully every time he had a headache. As a young frontiersman, Andrew became very expert with the rifle and hunted deer, turkeys, eagles, hawks, wild geese, wildcats, and foxes. He was a good judge of dogs, and quoted as an authority on the subject.

January 24th 2019

Groin pain - is it coming from the hip?

Groin pain can be a tricky problem because the location of the pain can often be a poor indicator of where the issue originates.  This can be further complicated if the problem becomes chronic (over about 3 months) as there can be an accumulation of different issues adding further layers of complexity.  It is very important therefore that your Osteopath or manual therapist makes a clear diagnosis and works through the possible possibilities thoroughly.

Causes of groin pain

It’s important to look beyond the diagnosis of ‘groin sprain’ - a strain or sprain of the adductor muscle or the psoas muscle tendons and consider the following:

1) Hip joint - perhaps surprisingly approximately 50% of groin pain can be attributed to the hip:  

i) Femoral Acetabular impingement syndrome (FAI) - the acetabular labrum (cuff around the hip joint) tears usually due to repetitive trauma or can be genetically predisposed. The pain can be worse with exercise, sitting or standing and can be brought on by bringing the leg towards the chest, turning it inwards and drawing it towards the middle of the body (i.e. compressing the groin area).  This issue needs to be addressed as ignoring it can lead to osteoarthritis in the hip in the long term.  FAI may require treatment with hip arthroscopy surgery but, in some cases, injection therapy and robust Osteopathy may be enough to get the person back to full activity.

ii)  Slipped epiphysis - teenagers can have a slipped epiphysis where the ball at the head of the femur (thighbone) slips off the neck of the bone in a backwards direction.

Iii)  Avascular necrosis - usually in 20 to 50 year olds, avascular necrosis also be a problem where the head of the femur receives less and less blood supply.

iv)  Arthritis - hip osteoarthritis can cause groin painv

V)  Hip bursitis - small fluid-filled sacs around the hip become inflamed and refer pain to the groin

2) Referral or nerve compression originating from the lumbar spine

3) Pubic overload (osteitis pubis) - inflammation of the pubic symphysis and the surrounding muscles often due to overuse or repetitive trauma such as in footballers or athletes

4) Abdominal wall hernias - may cause pain a little higher in the groin

5) Rectus femoris tear - rarer and in younger patients, the rectus femoris may pull away from its attachment onto the pelvis in the groin area

6) Testicular tumours - other symptoms may include night pain, severe pain on loading the leg, weight loss or systemic (body-wide) symptoms such as fever

If you are experiencing hip and groin pain, an osteopath can help. Your osteopath will assess your lower back and lower limb movement in order to work out the source and cause of your pain. They will look at the other muscles around your hip and groin to see whether they are impacting on your health. Your osteopath will then set out a treatment plan designed to help alleviate pain and return the affected area to normal health and movement.

January 24th 2019

Scoliosis

Scoliosis is a common spinal condition affecting at least 10% of people where the spine curves or twists (the word comes from the Greek word meaning ‘crooked’).  People with scoliosis, such as Princess Eugenie as was highlighted following her recent wedding, have either an ‘S’ or ‘C’ shaped spine.  The resultant shape can be one of two types:

  • Structural -     where the shape develops from the early teenage years
  • Functional -     develops as a result of our everyday lives and includes factors such as     prolonged periods of sitting, carrying or picking up children, carrying     heavy bags or slouching on the sofa at the end of the day.  

Who does it affect?
Scoliosis can affect people of all ages to varying severity.  Teenagers account for 80% of cases where scoliosis is of unknown case.  There may be a genetic predisposition to the condition, but the specific genes have not yet been identified.  The degree of curvature can be stable or progressive.  Girls and those with a larger curve are at an increased risk of progressive worsening of the curve.  X-Rays are taken to confirm diagnosis and assess the severity of the curvature.
 
Signs of a scoliosis?
Signs can include:

  • Uneven musculature on one side of the spine with complaints of     stiffness and soreness
  • A rib or shoulder blade prominence on one side caused by the     rotation of the rib cage/thorax
  • Uneven hip, arm or leg lengths or the waist may be higher on one     side than the other

Sufferers don’t necessarily experience pain or problems through their lives but, in some cases, it can be debilitating and lead to lung and heart capacity problems which can restrict activity levels.
 
Can Osteopathy help?
Treatment can depend on the degree to which the spinal curvature is affecting your, or your child’s, daily life or whether the condition is worsening.  Osteopathy can help by mobilising the thoracic and lumbar spine and the rib cage to increase the range of movement.  The pelvis also benefits from mobilisation especially where there is a leg length difference.  For example in the ‘C’ curve case, the chest and thoracic spine curve forward and compress with the muscles shortening on the front of the body and a hunch forming in the back.  Stretching and massaging these chest muscles, the psoas (hip flexor) muscles and other areas helps to open out the front of the body and release some of the tension.  Exercises and stretches will also be given for the patient to do at home.  These might include:

  • Standing hamstring stretches
  • The cat/cow stretch
  • The pelvic tilt
  • Gentle hip extension
  • Gentle spinal mobilisations and extension

It’s unlikely that the scoliosis will be completely corrected with Osteopathy but it can definitely be managed and the pain levels reduced.  Book in to get an assessment and, as well as treatment, we can go through the above exercises and more advice as appropriate.

As with Princess Eugenie who had her spine operated on when she was younger, other interventions may be appropriate. Close-fitting braces may be used day and night to prevent the scoliosis from worsening and, if severe, surgery may be recommended.  This involves placing pieces of bone or bone-like material in-between the vertebrae with a rod, metal hooks, screws and wires holding the spine straight while the old and new material fuse together. The rod can be adjusted and lengthened every six months to allow for growth.

January 23rd 2019

Ankle, Achilles & foot pain

The ankle and foot complex is a combination of interconnected small bones linked together by muscles, ligaments and fascia (similar to cling film which envelopes all the structures in the body) which together give stability, flexibility and strength for proper function. There are a number of conditions which commonly cause pain in the feet or ankles:

Flat-footedness or pronation – this is when the medial or inner arch of the foot starts to flatten or collapse and the foot rolls over to the inner side (resulting in over-pronation). Often this is evident when the shoes wear out unevenly or on one side. Over-pronation can cause problems further up the chain, resulting in injury to the Achilles tendon (at the back of the ankle), shin pain, knee pain and even, indirectly, hip and back pain. Symptoms include pain, swelling or a change in foot shape.

Plantar-fasciitis – is when the fibrous tough fascia supporting the arches on the bottom of the foot, particularly between the ball and heel of the foot, become painful and inflammed. Symptoms often include sharp pain occurring predominantly under the heel or around the medial or inner arch of the foot and numbness, tingling or swelling in the same area. Aggravating factors include standing for long periods, especially when wearing non-supporting or poor footwear or when standing up having been inactive for a while. Occasionally a small spur of bone where the plantar fascia is pulling on the front of the heel which increases the symptoms causing more pain. Advice would be to freeze a bottle of water, cover it with kitchen roll or similar, put it on the ground and roll your foot over it for 5 – 10 minutes a couple of times a day or more. Also, go to the Osteopath to be treated and have calf exercises prescribed.

Achilles tendonitis – The Achilles tendon is a thick tendon continuing from the calf muscles down the back of the leg, behind the ankle and blending in with the plantar fascia and the heel bone (or calcaneus). It can be injured, strained and inflammed through sport, over-pronation (collapsed arches) and rarely can be painful due to some arthritic conditions.

Metatarsalgia and Morton’s neuroma – these conditions mostly relate to problems in the area of the ball of the foot, either as a result of bruising of the toe bones (particularly the 2nd and 3rd toes) or the nerves between the toes becoming irritated. Often these problems relate to over-pronation or dropped arches, a mobile mid-foot and/or callus build up between the toe bones. The area can become painful and swollen. Advice includes putting a foam pad under the ball of the foot to give some cushioning, have the Osteopath treat to improve overall foot and leg mechanics and prescribe exercises and arrange a biomechanical assessment with a podiatrist to have orthotics or insoles fitted as appropriate.

Sprained ankle – can result due to a sudden twisting or ‘going over’ on the ankle joint. More often, the ligaments on the outer side of the ankle are injured and strained leading to bruising, swelling, pain and instability. An X-Ray may be required to ensure that the ankle is not broken. Rest, elevation and compression are usually advisable in the first 24 – 48 hours after injury.

Gout - is intermittent and acute redness, swelling and pain, particularly around the big toes but it can be elsewhere in the foot or other joints. It results from a build up of uric acid in the blood that becomes deposited in the joints and starts an inflammatory process. Eventually gout can lead to arthritis of the foot.Most of these conditions can be treated by an Osteopath with a variety of gentle soft-tissue massage, stretching and articulation and manipulation as appropriate. Exercises and stretches are often then prescribed to improve strength, balance or loosen the foot, ankle and leg. Advice may also be given on strapping and footwear and podiatrist recommended if insoles or specialist foot supports are required. You may be referred to your GP if medication or further X-Rays or scans are required.

January 22nd 2019

Prolapsed or 'slipped' disc in the back or neck

There are lots of terms used for problems associated with the discs in your back including ‘slipped disc’, 'ruptured disc’, 'herniated disc’ and 'strained disc’ but what is a disc, what is actually happening when they 'slip’ and can an Osteopath fix it?

First the anatomy, the disc is actually called an inverterbral disc – a structure found between the vertebrae similar to a tyre with the tyre part being a tough fibrous outer ring and the centre being gel-like. There are 23 discs in the spine. The disc acts as a shock absorber, giving the spine its curves and joins the spine together. Over time, this shock absorbing capability reduces as the disc wears and looses height due to fluid loss. Small cracks appear in the outer walls and, if put under undue strain, the disc can start to be pushed out of shape and bulge. If the strain on the disc continues, the inside gel-like nucleus pushes through the outer walls (annulus) causing what is called a disc prolapse ('Slipped disc’ is actually as misnomer as the disc doesn’t actually slip anywhere).

This prolapse can press on the nerves of the spine causing tingling, numbness, pain or power loss in the arms or legs depending on whether the problem is in the neck or low back. In some cases, severe prolapses can press on the spinal cord causing compression which requires urgent medical attention. Osteopaths are trained to recognise any of these signs and act accordingly – referring as appropriate. Mild or severe, standing, sitting, walking, sneezing, coughing and bowel movements can be difficult.

Whether it is a protrusion, minor strain or prolapse, the disc has sustained physical damage which requires time to resolve and repair. Osteopaths encourage this repair by establishing why the particular disc was the one that had the problem in the first place (possibly trauma or wear and tear for example) and then treating to ensure that the spine is optimally placed to enable healing and the protective spasm around the problematic disc is eased. As management of a discal problem is key, advice will also be given to the patient including postural tips, hot or cold packs and stretching as appropriate and recommending that they stay as mobile as possible.

The traditional medical approach to a disc problems is often to offer a combination of pain-killers and muscles relaxants which can work in conjunction with Osteopathic treatment to resolve the disc problem more speedily. If the problem persists or there are any worrying symptoms, the patient can be referred back to their GP for further investigations and, if all else fails, on to a specialist if an operation is required.

January 21st 2019

Back pain: Prevention is better than cure

Back pain causes 5 million people to consult their doctor every year and will cause pain to one in 5 of us at some point in our lives.
In the majority of cases the problem comes on slowly, starting as back ache, reduced movement and can also include shooting pains into the legs. It can be caused by many different factors including arthritis, trauma, slipped discs or sciatica - leg pain due to trapped nerves. More recently it has been linked to people having increasingly sedentary lives rather than the traditional industry related injuries such as burns and cuts. Increasingly doctors are left with limited options (such as medications and physiotherapy for which there is often a long waiting list with which to help patients) so the person is left trying different therapists and therapies for a cure.
Research seems to show that surgery is not a quick fix for back pain and is only necessary in less than 4% of cases. It indicates that prevention is indeed better than cure and that exercise and good posture are very important, particularly in conjunction with a therapy such as Osteopathy.
Weak stomach and back muscles mixed with a sedentary lifestyle is a recipe for bad backs. Exercise strengthens the core muscles of the abdomen and spine and eases the tension in the back. Any exercise is good, although it is best to avoid high-impact sport if you have just had an episode of back pain – perhaps stick to walking, cycling and cross-training for example. Try and aim for at least 30 minutes of exercise 3 times per week where you are getting your heart pumping a bit harder than when you are at rest (you are working too hard if you are not able to talk while you are exercising). One session per week of pilates or yoga is also recommended as an ongoing means to avoiding back pain. Both are very effective, although it always important to proceed through each exercise slowly if you are a beginner and only attend classes with teachers who are moving around the room and watching that you are doing the exercises correctly. One to one classes are the ideal way to get personalised instruction and introduce you to exercises at your pace.
Start the day with some gentle knee hugs and stretches and then make a habit of taking regular breaks from your computer if you are very sedentary at work – every 45 minutes or so – perhaps doing some of the exercises below to keep yourself pain-free.
1. Neck stretch - reach down and hold on to the side of the chair with the right hand while gently tilting your head to the left. Feel the stretch down the right side of your neck and shoulder. Hold for 20 seconds and repeat on the other side.
2. Place the band over in a wide grip over the head. Take the arms back so that you stretch out the front of the chest. Hold for 20 seconds. Avoid if you have shoulder problems.
3. Spinal twist - with your feet flat on the floor, tighten the abdominal muscles and gently twist your upper body. Only twist as far as is comfortable and keep your back straight and hips facing forward. You can hold onto the side of the chair to deepen the stretch. Hold for 25 seconds and repeat on the other side.

January 20th 2019

Sports Injuries

Sports activities are a regular way of life for many, and involve people from across all age groups from those who have an avid interest to those who just wish to keep fit; from the elite professional to the casual participant. Many of the injuries are the result of overuse i.e. playing too hard and too often e.g. tennis elbow, golfer’s elbow, and biceps tendinitis, or from not warming up properly beforehand or from not warming down after exercise.

Sometimes incorrect equipment can lead to injuries – ill-fitting footwear can cause hip, knee and foot injuries (e.g. Achilles injuries). Reduced joint flexibility will affect the degree of performance and may result in injury if the player is unaware that they cannot perform to the same level as they used to, for example golfers who cannot turn at the waist as well as they used to, and the enthusiastic older footballer whose knees do not bend as well as they once did.

Young people especially are vulnerable in sport as their growing bodies are often expected to perform to high standards and are putting exceptional physical demands on themselves. The good news is that although sports injuries are common, those who are fit tend to recover more quickly and easily from their injuries.

An osteopath can help improve performance as well as treat the injuries being suffered.
By using their knowledge of diagnosis and highly developed palpatory skills they can
help to restore structural balance, improve joint mobility and reduce adhesions and soft tissue restrictions so that ease of movement is restored and performance enhanced.
For those of you wishing to keep fit, the osteopath can help you keep supple and
improve muscle tone so reducing the risk of injury to soft tissues unaccustomed to the extra work they are being asked to do. Advice on diet and exercise, which will help you with your specific sport, may also be offered.

Tips to remember:

1. Begin slowly and build up, especially after an injury
2. Warm up first, and then warm down with stretches afterwards
3. Drink plenty of water when exercising
4. Exercise regularly, and try to alternate the types of exercise that you are doing every day
5. Following a joint injury apply ice to the area for 10 minutes, every hour, if practical.
6. Apply a bandage to compress the tissues. Elevate and rest if possible.

January 19th 2019

Spinal stenosis

Spinal stenosis occurs when the space around the spinal cord narrows – most commonly in the lumbar spine and less so in the cervical spine. As the space narrows and pressure is put on to the cord, the blood and nerve supply are pinched and everything lower down in the body from the level where the stenosis is taking place can be affected.

The narrowing can be due to osteoarthritic changes where your body starts developing new bone, particularly around the facet joints at the back of the spine, to try and support the spine. This bony growth can cause encroachment within the central spinal canal or the foramina on either side of the spine where the nerves exit to supply the arms or the legs. The ligaments can also thicken which may increase the encroachment. A much less common cause is when there is vertebral collapse.

Patients with spinal stenosis usually present with back or leg pain (of one or both legs) which is often worsened when the patient walks beyond a certain distance and eased with rest. The patient may describe a feeling of tiredness, cramping or numbness in the legs which relieves when the patient rests and draws their legs up to their chest and takes the pressure off the spinal cord or nerve roots.

Spinal stenosis is most common in the those over 50 with spinal osteoarthritis and degenerative changes, however it can occur as a result of other conditions including:
• Paget’s disease
• Ankylosing spondylitis
• Hyperparathyroidism
• Congenital reasons

For those with spinal stenosis, it is most important to be aware that, in the worst case, the pressure on the spinal cord or nerve roots can be a medical surgical emergency. This is when the cauda equina (the amalgamation of nerves at the base of the spine) is compressed. If left untreated, the patient may experience loss of bowel or bladder control and weakness or paralysis of both legs. It is therefore vital to ensure that spinal stenosis is diagnosed and treated as early as possible.
Osteopathy, often in conjunction with acupuncture or dry needling as appropriate, can be a very effective treatment for this often painful condition although it has to be appreciated that the clock cannot be turned back. As spinal stenosis is usually a chronic condition which has taken years to develop, it can take quite a bit of time to really reduce the symptoms. That said, Osteopathy can often prevent a worsening of the spinal stenosis and vastly reduce the need for surgical intervention.

January 9th 2019

Stress management and Osteopathy

We all get stressed at some, or many, points in our lives. Have a look at these 20 tips for managing stress when it hits:

• Be active – gentle cycling, swimming, walking, gardening or any other exercise works wonders
• Breathe deeply - expanding your lower rather than upper rib cage when breathing in
• Get plenty of sleep. Be aware of when you are tired and take steps to refresh yourself
• Eat sensibly – fresh fruit and vegetables, wholemeal bread and pasta and cut down on fat and sugary foods
• Take time to relax daily
• Talk to someone you trust
• Remember to accept what you cannot change
• Avoid self-medication – cigarettes, alcohol and coffee
• Take time to play
• Do one job at a time
• Agree with someone for a change
• Look at how you manage your time and set a timetable – do not overload it
• Do something for others
• Accept when you are sick and do not pretend that you feel fine
• Remember that the answer lies with you
• Delegate to colleagues, family and friends rather than trying to do everything yourself
• Develop an absorbing hobby
• Don’t be afraid to say ‘NO’
• Be realistic about perfection and what you can achieve
• Recognise that you are a person with worth – just as you are

These 20 tips for stress management should be tempered with the fact that it is sometimes difficult or impossible to remove a stressor from your life. It is important to remember that one of the tenets of Osteopathy is that the mind and body are interdependent and that the stress ‘fight-or-flight’ response of the body often directly results in negative emotions and vice versa. Osteopathic treatment of the body to relax the muscles and ease breathing can encourage a return to optimism and health and ease the stressful symptoms and emotions. Specifically, gently stretching of the ribs and releasing restrictions in the thoracic spine with massage, articulation and thrusting (as appropriate) can alleviate the restrictions and tension you experience when you are stressed and improve your sense of well-being.

January 8th 2019

Referred pain

A hugely common question asked of Osteopaths is…”What is referred pain?”. Referred pain is a strange term which relates to pain felt in an area which is not the actual location producing the problem - the origin of the pain.

It is caused by the network of interconnecting sensory nerves which converge in the spinal cord effectively getting confused and linking areas which are supplied by the same nerves resulting in pain and other symptoms. A good example is headaches, in which pain caused by problems in the joints and muscles of the neck or jaw lead to referred pain in the base of the skull and in many areas over the head, forehead, around the eyes or into the temple areas.

Another perhaps stranger example is called viscero-somatic pain referral. The viscera are the internal organs of the body and the soma is, essentially, the musculo-skeletal part of the body. One of the most common pain referral patterns occur during a heart attack where nerves from the heart convey pain to the spinal cord of the upper back (T1 - 4 vertebral levels). As these levels also supply sensation to the left arm, left side of the chest and, less frequently, up towards the left shoulder and neck people can experience pain, tingling and numbness in these areas when having a heart attack. The brain is not used to receiving such strong signals from the heart and perceives them to be originating from the left arm and chest. (Please be assured that left arm and chest pain does not always mean you are having a heart attack - likelihood is that the pain will be of musculo-skeletal origin. Do seek medical attention if you are in doubt). A similar referral pattern can happen between the gall bladder and the right shoulder as an inflamed and irritated gall bladder can prompt a pain impulse in the diaphragm (the domed respiratory muscle under your ribs) which has a nerve supply from the same level as the right shoulder.

In all cases, referred pain is often felt as quite a diffuse, dull ache which is difficult to locate and may vary in severity. For example, clear sciatic nerve impingement (originating from the lower back or tension in certain muscles in the buttocks) often creates pain or sensory symptoms like tingling or numbness as a fairly clear line down the back of the leg possibly past the back of the knee towards the calf and ankle. Referred pain, say from the lumbo-sacral joint at the base of the spine, may cause only diffuse achy pain in random locations in the buttocks and into the back of the thigh and possibly calf. Local assessment of the thigh muscle may result in no abnormal findings however if the symptoms have been prolonged, the patient may experience tenderness, tightness or weakness in the back of the thigh.

A thorough examination by the Osteopath will establish whether the symptoms you are experiencing are referred or local to the site where the pain is being experienced. Further investigations may be required to achieve this diagnosis but often simply examining and assessing is sufficient and treatment results in a great improvement.

January 7th 2019

Fitness training - tips to avoid in injury

Many people start a fitness campaign with gusto at the start of the new year. This is great, however injuries often occur when there is a sudden rather than paced increase in duration, intensity or frequency of their activities. Many soft-tissue injuries can be avoided through proper conditioning, training and equipment. Other tips include:

·  Balanced fitness - develop a programme that includes cardiovascular exercise (at least 3 x 30 minutes of activity which increases your heart rate per week), strength training (particularly important as you get older) and flexibility (a yoga or Pilates class or session at least once a week).

·  Don’t do too much too fast - add new activities and exercises carefully whether you have been sedentary or very active and do not try to take on too many new exercises at any one time. Too much of an increase in weight or distance too quickly can set you back severely. Overtraining and not allowing the body adequate rest periods can exhaust the body and set you up for an injury.

·   Use proper equipment - change your trainers as often as every 6 months if you are very active or as they start to show signs of wear. Wear comfortable, loose-fitting clothes which let you move freely and release body heat.

·  Keep hydrated - have a drink at least every 15 minutes or so while you exercise and drink water regularly in your day-to-day life to rehydrate you.

·   Warm up - before your exercise routine, slowly increase from a walk to a jog, spin on a bike or gently mobilise your arms and legs jogging on the spot and revolving your arms. Warming up increases your heart rate and blood flow and loosens up your tendons, ligaments and joints.

·  Cool down - in my view this is more important than warming up and it should be the final part of your exercise routine. As your muscles cool immediately after cardiovascular exercise (even sports like swimming), stretching is vital to prevent them from shortening and tightening. Slow your movement or activity down in the last 5 minutes before you stop and then begin stretching slowly and carefully until you reach the point of muscle tension. Hold each stretch for 10 to 20 seconds and then slowly release ideally repeating 2 or 3 times for each muscle group. Don’t bounce the stretch. For example, if you have been running or cycling, make sure you stretch all the leg (calves, hamstrings, quads), buttock and low back muscles and include rotational stretches of the back. Stretching after all exercise will not only avoid short term injury but will also prevent injury in the future.

·   Rest - schedule regular days off from vigorous exercise and rest when tired.

·   Don’t just exercise at the weekend - try to get at least 30 minutes of moderate exercise every day, breaking it up into 10 minute chunks if you are pushed for time.

January 6th 2019

Osteopathic management of patients during pregnancy

I regularly treat pregnant women with a variety of symptoms ranging from low to mid back pain to pelvic girdle pain (including sacro-iliac and/or pubic symphysis dysfunction), rib pain, sciatica and general discomfort - particularly later in the pregnancy as the baby grows bigger. Having carefully established the diagnosis once I have taken the case history and examined, I use a number of different treatment techniques including soft-tissue massage, joint articulation, muscle energy techniques and manipulation as appropriate to ease the patients symptoms.

So it’s interesting to read The UK National Council for Osteopathic for Osteopathic Research (NCOR) report from 2012 which discussed the Osteopathic management of patients during pregnancy. The key findings were as follows:

Symptoms
• One of the most frequently cited symptoms of pregnancy seen by osteopaths is low back pain.
• Other symptoms include heartburn (for which there is acknowledgement of osteopathic treatment but currently little evidence), carpal tunnel syndrome, sacroiliac pain, mid thoracic pain and gastrointestinal symptoms.
• Differential diagnosis for carpal tunnel syndrome should include diabetes and thyroid disease.

Osteopathic Studies
• One study has found evidence that pregnant patients who received osteopathic care experienced improved outcomes in labour and delivery compared to those who didn’t.
• Another study has shown that osteopathic manipulative technique may help to improve or stop the deterioration of back-specific functioning in the third trimester of pregnancy.
• Non-supine positions during labour and delivery have been found to have clinical advantages including increased perineal integrity, reduced vulvar oedema and reduced blood loss.

Relaxin (the hormone which relaxes joints in the mother’s body ready for birth)
• It is still not established if higher levels of relaxin relate to a higher incidence of pelvic girdle pain in pregnancy; more studies have shown that there is no positive relationship.
• There is still a large gap of evidence in this subject area.

January 5th 2019

Knee pain

The knee is the largest and most complicated joint in the body which consists of many structures which, if damaged by anything from an acute traumatic event to general wear and tear over time, can require quite a bit of rehabilitation to correct.

Here are some of the more common knee problems:

• Osteoarthritis – essentially this is wear and tear of the knee which can be treated effectively, especially if the treatment is started early. You may find that your knee is aching or painful after certain activities such as climbing stairs with stiffness present particularly in the mornings or after rest. Pain may be experienced within the joint, all around it or in one place. There are many causes for osteoarthritis of the knee including pelvic torsion that results in more pressure being put onto one knee than the other or it may be due to secondary to osteoarthritis of the spine.
• Referred pain – knee pain may be referred from compression of the nerves supplying the knee at various levels down their course to the knee from the low back. It may also be referred from trigger points in muscles further up or down the leg.
• Biomechanical issues - such as kneecap lateral tracking (moving towards the outside) occur as a result of many issues including dropping of the foot arches, knock knees, lack of tone of the quad muscles nearer the inside of the leg(s), leg length differences or pelvic torsions.
• Chondromalacia patella - is related to the above issue where the underside of the knee cap becomes irritated as it passes along the groove at the base of the femur (thigh bone) often due to mal-tracking. Going up stairs or deep knees bends can be painful.
• Bursa inflammation – Bursa are like tyres filled with viscous fluid-like material which act as pads between muscles, tendons and bones around the knee. These can become irritated and inflamed, most commonly causing pain just above or below the kneecap.
• Children - Osgood Schlatter’s disease, where the quadriceps muscle at the front of the thigh pulls at the surface of the bone where its tendon attaches just below the knee. This often results in a painful, visible lump. Never ignore persistent knee pain in a child as there are serious diseases which need to be excluded.
• Sports injuries
Cruciate ligament tears/collateral ligament tears – the cruciate ligaments are found within the knee joint. Tears can occur when excessive force is applied to the knee joint with the anterior cruciate being affected the most often. Other structures such as the joint capsule and the collateral ligaments on the inside and outside of the knee are also commonly damaged. If there is a major tear there will be sudden and painful swelling in the knee at time of injury and the knee will feel unstable.
Meniscal/cartilage tears – the meniscus/cartilage is found lining the ends of the tibia and femur (shin and thigh bones that meet in the knee). Damage often occurs to these structures when the knee is over-rotated.

My job as an Osteopath is to assess the joints and muscles of the knee, hips, back and feet holistically focusing on everything so that the cause of your knee pain can be determined. The problem will then be treated with soft tissue massage, articulation, stretching and manipulation as appropriate. Advice may also be given on effective exercises and hydrotherapy (hot and cold packs) and medication. If need be, you will be referred for further medical assessment.

January 4th 2019

Workstation set-up

Quite a number of my desk-working patients are presenting to me with back, neck and other problems such as tennis elbow because they are spending hours at a workstation which is not properly set up for them.   Here are some key factors to consider to ensure that your workstation is helping and not hindering your mental and physical well-being:

Chair

    • Ensure that your hips are higher than your knees your feet are flat on the floor or foot rest.  Adjust your desk height if possible rather than adjusting your chair height to suit a lower desk height.   Use a foot rest if your feet are not able to touch the ground.
    •  Seat depth - you need to be able to sit back in the chair to get enough support from the back rest but there should be about a fist’s width between the back of your knee and front of the seat. Consider using a pillow, cushion or lumbar support behind your lower back if your thigh length is not long enough.
    •  Seat tilt -  can be used to ensure that your hips are slightly higher or level with your knees (you are aiming for a 90 to 120 degree angle at the hip).
    •  Arm rest - ideally you have adjustable arm rests which do not stop you from drawing your chair close to your desk (you are better removing them if they get in the way).  They should be supporting the elbows while the shoulders are relaxed.

Desk height

    • Ideally you can use an electronically (or peg or screw system) adjustable desk to prevent it being too high or too low for you.  Desk raisers can be obtained to increase your desk height.
    •  Your elbows should be level with or very slightly higher with the desk top when they are at a right angle and your shoulders are relaxed.  

Monitor

    • The monitor should directly in front of you at arm’s length and at a height where the top is at eyebrow level. Avoid twisting to see your monitor.  Position it at 90 degrees to any light source to avoid glare.
    •  If you are using a laptop, consider piling the laptop on to a pile of books (or use a laptop raiser) so that the screen top is at eyebrow level and buy a separate bluetooth or attachable keyboard and mouse.  These changes should prevent neck, back and arm or hand problems.
    • Copyholder - if you are referring to paperwork a lot while using a computer, consider using a copyholder attached to the side of your monitor to avoid long periods of neck flexion.

Keyboard and mouse

    • Ensure that your upper arm and elbow are close to your body, your arm is bent at approximately a 90 degree angle at the elbow, the forearm parallel to the desk and you are as relaxed as possible.  
    • Avoid over-reaching for the mouse and keep the wrist as straight as possible when using it or the keyboard.  You could consider buying a gel wrist rest to help achieve this position.

Telephone

    • Consider buying a headset if you use the phone a lot and avoid cradling the phone between your head and shoulder.  

Also…

    • Remember to sit tall and try not to slouch
    • Take regular breaks from your desk every 35 to 40 minutes to avoid postural fatigue (where the muscles become tired and sore from lack of movement)

January 3rd 2019

Sports injuries of the shoulder

Patients often present with problems in the shoulder area that start with microscopic muscle tears and strains as a response to heavy exercise and, as the person continues to exercise without leaving enough time for the body to deal with these strains, the passing aches a few days after a workout worsen to become regularly painful. They haven’t left enough time for recovery.

This cumulative injury commonly occurs in the shoulder as, unlike the hip joint for example which is very congruent with the ball and socket fitting tightly together, it is all about the muscular balance. Often the rotator cuff and other muscles connecting the arm to the main part of the body via the shoulder become unbalanced and muscles like the biceps overwork to try and compensate for weakness and instability. The tendon of one of the heads of the biceps passes through a narrow groove at the top of the shoulder (the bicipital groove). This tendon becomes inflamed and sore as the person trains more and fails to rest sufficiently. If any area continues to be inflamed, tissue repair is inhibited and damage may occur.

In the case of bodybuilders, what starts at a little niggle in the upper arm indicating that the biceps tendon might be being compromised, progresses steadily to be a debilitating injury which requires rest. For any serious bodybuilder or athlete, these enforced rests can be a major handicap to progress however if the person continues stressing the shoulder, they may be forced to stop training completely. It’s therefore better to seek treatment at the niggle stage rather than wait until the shoulder is regularly painful. If their shoulder does become persistently painful and sore, they should also avoid the exercises below - especially if they involve using the body as resistance. They should go for increased repetitions with lighter weights. The lighter style of training will flush blood through the area promoting recovery and, at the same time, enable the trainer to hold on to the hard-gained muscle. In addition, they should apply ice to the top of the arm / front of the shoulder area to reduce the swelling and inflammation in the area - particularly after training.

The specific exercises in bodybuilding that make people more prone to these kinds of injuries are: parallel bar dips, close grip bench press, shoulder press to the front, incline dumbbell curls, chest pullover across bench and chin and flat bench flying (particularly when going to low).

January 2nd 2019

Cranial Osteopathy - treating babies

There are a number of reasons why parents bring their babies to a Cranial Osteopath like :
• Delivery types - babies delivered using forceps or ventouse can cause tension in a baby’s head which can result in a cone head or even bruising from the forceps. Babies can show their discomfort by crying particularly when their head is being touched or when they are laid down on their backs or have clothes or hats put on them. Cranial Osteopaths can identify and release these tension patterns.
• Breast feeding issues - if there is tension in the jaw joints or other bones of the baby’s head, neck or whole body which are involved in their latch and suckling then their feeding can be difficult and they can take in air and be have colicky symptoms. Also, quite often an intense or difficult birth can lead to the baby finding it difficult to find a comfortable position to feed. Often babies prefer to turn their heads to the right rather than the left to feed. In all these cases, Cranial Osteopathy can help release these tensions and help with breastfeeding - enabling you to feed the baby longer if you wish to do so.
• They won’t stop sucking - babies who constantly suck, cluster feed or snack can result in mothers giving up breastfeeding as they are exhausted and in pain. They are often not doing so because they are hungry but because, firstly, the sucking motion is calming to them and releases pain relieving chemicals and, secondly, sucking actually relieves the tension in their head (possibly caused by a traumatic or forceps or ventouse delivery). Treatment can help ease these tensions, calm the baby and the sucking reduces so that they only eat when they are hungry.
• Babies needing to be held continually or swaddled - often these babies have had a shocking or surprise delivery. Babies who have experienced a C-section, a fast delivery or some sort of stress around or just before delivery can be in a state of stress or anxiety which manifests in wanting to be constantly held, being very light sleepers or being jumpy or needing swaddling. The gentle nature of Cranial Osteopathy can ease this anxiety and lower the tone of the nervous system.
• The stiff arching back baby - also noted for their ‘strong’ neck although their necks are not strong they’re stiff. These babies arch a lot and throw themselves backwards. In this case, the delivery has usually been quite long and they may have got stuck low down or engaged for a long time prior to delivery. This long duration of compression leaves them upset and cranky and they struggle to sleep or don’t like lying on their backs. Again, Cranial Osteopathy can help relax and calm them by releasing the compressive tension and relaxing the ‘wired’ nervous system.
• Curled up ‘little frog’ baby - these babies usually have their knees curled up so they are like a little ball. Often these babies have had a surprise like a C-section or a fast birth and therefore haven’t had their bodies stretched out properly as they travelled through the birth canal. This curled knees up position can result in windy, colicky and reflux problems all of which can be relieved with treatment.
A check-up anytime from about 4 weeks after delivery really helps to minimise these problems and ensures that the baby’s alignment is correct and their nervous systems are calmed and unwound.

January 1st 2019

Exercise therapy in the management of hip and knee Osteoarthritis

The National Council for Osteopathic Research have provided a snapshot summary (2017) of key Osteopathic and Osteopathically relevant literature on the subject of Exercise therapy in the management of hip and knee Osteoarthritis (OA). OA is a very common condition affecting over 8.5 million people over the age of 45 in the UK. It is effectively ‘wear and tear’ where the cartilage within the joints of the body starts to wear away and various other changes take place within the joint. The muscles around the joint start to tighten and stiffen resulting in symptoms including gradually developing pain aggravated or triggered by activity, stiffness lasting under 30 min on awakening and after inactivity and occasional joint swelling. Management of OA is divided into three areas: pharmacological; non-pharmacological; and surgical. Appropriate exercise or physical activity is recommended in all patient groups, irrespective of demographics, severity of the condition, and pain levels experienced.

Although it may seem sometimes counter-intuitive, there is strong evidence that exercise reduces OA pain and improves physical function. The 2014 NICE guidelines for the care and management of osteoarthritis in adults suggest that exercise is appropriate for all sufferers of osteoarthritis, irrespective of age, comorbidity, and pain levels. They also recommend a mix of aerobic and strength exercises, and that the patient be encouraged to carry out the exercise themselves.

The main findings of the report were as follows:

• There is strong evidence suggesting that exercise in general can help patients manage the pain of hip and knee osteoarthritis (OA).
• The benefits of exercise on pain levels continue after the intervention period, with some patients reporting a reduction in pain for between 3 - 18 months after cessation.
• Appropriate exercise can be prescribed irrespective of age, pain level, comorbidity and disability. Catering to the patient’s specific needs and circumstances may improve adherence, which is important for improvements in outcomes.
• Exercises in group or individual settings are equally effective, so patient preference should drive this decision.
• There is no evidence to suggest that one type of exercise (aerobic, strength, or range of motion) is superior to another. Management plans often combine these approaches in an attempt to improve effectiveness.
• There is some evidence that specifically strengthening the muscles of the leg through resistance exercises will reduce pain in sufferers of knee OA.
• Effectiveness of specific exercises, dosage, frequencies and intensities are unclear due to a lack of both quality and quantity of data.

January 1st 2019

 

Philip Bayliss, Registered Osteopath, 43 Thames Street, St Albans, Christchurch, NZ. ☎️03 356 1353