But I Just Feel Too Tired To Be Fighting…

Fatigue is generally defined as the feeling of having a lack of physical or mental energy, or both. Fatigue is not to be confused with drowsiness, but the desire to sleep may accompany fatigue, as it does with drowsiness. Apathy, a feeling of indifference, may also present with fatigue or independently. A variety of terms are often used describing the feeling of fatigue, including being weary, tired, exhausted, feeling malaise and run down.

What causes fatigue? In approximately 40% of cases, a physical cause is thought to be responsible, with the other 60% thought to be caused by emotional or mental issues. Some common cause of fatigue include:

  • metabolic or endocrine disorders (anaemia, thyroid, diabetes)

  • infectious diseases (mono, hepatitis, TB, HIV, flu)

  • heart or lung conditions (heart failure, heart disease, asthma)

  • medications (antidepressants, blood pressure medications)

  • mental health conditions (depression, anxiety, grief, eating disorders)

  • sleep problems (sleep apnoea, insomnia)

In contrast to ‘disease-related’ fatigue, fatigue occurring in healthy individuals is quickly relieved after a few hours when physical or mental activity is reduced. Fatigue can also be experienced after a large meal, which is often a normal response, lasting from 30 minutes to several hours. In addition to the feeling of fatigue, there are often many fatigue syndromes quoted in medical literature. There is, however, only one well-defined such condition, chronic fatigue syndrome (CFS).

Broadly speaking, there are two sets of criteria that need to be met to establish the diagnosis of CFS:

1. Have severe chronic fatigue for at least six months or longer with other known medical conditions (whose symptoms includes fatigue) excluded
2. Concurrently have four or more of the following:

  • post-exertional malaise

  • impaired memory or concentration

  • unrefreshing sleep

  • muscle pain

  • multi-joint pain without redness or swelling

  • tender cervical or axillary lymph nodes

  • sore throat

  • headache

It is, therefore, vital that practitioners and their patients spend time together to determine whether the problem or symptom truly is fatigue, and if so, any associated symptoms should then be explored.

Osteopathy can help with CFS, as demonstrated by a 1998 study at the University of Salford, which found a 40% improvement in patients with CFS having osteopathic treatment (the Perrin technique), compared to a 1% worsening in those not having osteopathic treatment. As the whole body is supplied by nerves exiting the spinal cord, any restriction in spinal movement can affect these nerves, which supply the limbs, internal organs, glandular and immune systems of the body.

Osteopathic treatment for CFS can include soft tissue work (working on the tissues to relieve tension), articulations and manipulations (mobilising, stretching and manipulating the joints to relieve stiffness). Cranial osteopathy has also been found very useful in the treatment of CFS. There are also a few exercises that can be used to complement osteopathic treatment:

  • lay on your back for 10 minutes with knees bent up and the back of your head resting on a thick book. This will help loosen the muscles around the neck (ensure that the base of the skull, where it meets the neck, is resting on the edge of the book)

  • to loosen the thoracic vertebrae (upper back), there are a couple of positions, requiring you to sit on the edge of a chair before following through with the following: Position 1: place your palms by the side of your neck, with shoulders relaxed and elbows pointing downwards. Turn your head and upper body slowly by 30 degrees and back, repeating between 10 – 15 times. Position 2: cross your arms in front of you so that your elbows are touching like a ‘self-hug’. In this position, carry out the same slow movements that were carried out in Position 1.

If you suffer from fatigue or muscular/joint pain issues, or are unsure whether osteopathy can help, it may be worthwhile coming to see us at Atlas Osteopathy (with clinics in East Finchley and Moorgate, as well as the option of home visits), where we can explain your problems to you, why they occur and whether or not you are suitable for osteopathic treatment. Often this can be done via email or on the phone.

Don’t hold your breath ’cause we’re running in circles…

Breathing is the most basic and essential function by which we live and function, both physically and mentally. As babies, we are born with the inherent knowledge of how to breathe correctly, through our DIAPHRAGM. But as we progress into toddlers, children and adulthood, our life experiences and emotions influence our unique breathing pattern, and more often than not, this a negative influence. It is estimated by experienced clinicians that approximately 70% of patients seen do not breathe properly, as we did when we were babies. This may appear unusual, as breathing is a subconscious activity, and as such, unless we have an obvious breathing problem (e.g. asthma) we do not usually notice our breathing. We need torealise that our emotions influence our breathing patterns, but just as importantly, our breathing affects our emotions and performance.

You may notice in yourselves or others that we may sigh frequently, find it difficult in catching our breath or we may talk to fast, (like Laura from The Apprentice). These are all signs of not breathing properly. As children, our parents often told us when we were upset or angry to “take a deep breath and count to 10” before reacting to a negative event. It is, therefore, no coincidence that disciplines such as Tai Chi, Pilates, Yoga and meditation all pay particular attention to breathing as their main way of helping people to relax. Many of these approaches have validated scientific evidence of their effectiveness in helping many medical conditions, from pain to cardiovascular disease.

Those of us suffering with complaints and ill health, with medically unexplained symptoms, will often have breathing pattern disorder as part of the problem. These are usually functional disturbances in our bodies, affecting one or a combination of the levels listed here – biomechanical, nutritional, and emotional. All three levels are linked by breathing.

We all know basic breathing physiology and that when we breathe in, we are breathing in oxygen and when we breathe out, we are breathing out carbon dioxide. However, as I recently discovered myself, it is not as simple as that! The main aim of respiration is to get oxygen into cells to help with energy production, and the many cellular reactions required by the body to survive, depend on adequate levels of carbon dioxide being present in our body.

When we don’t breathe properly, the issue is almost always one of over-breathing. The result is that we breathe out too much carbon dioxide (not to be confused with the potentially poisonous carbon monoxide), and so the level of carbon dioxide in our body drops, known as hypocapnia. This reduces the ability of oxygen to be delivered to the cells of the body, known as hypoxia. The irony is that trying to breathe in more oxygen does not necessarily help this situation. Someone who is hyperventilating (breathing fast and deep), often with symptoms of breathlessness and panic, is breathing in lots of oxygen, but at the same time expelling more carbon dioxide than they should. The treatment for an acute episode of this is to hold a brown paper bag over their mouth and nose, so that they re-breathe their own breath, which is mostly carbon dioxide. They return to normal as cellular levels of oxygen then increase, as a result of carbon dioxide levels returning to the required level.

So how is a breathing pattern disorder diagnosed? Aside from the history and habits described above, correct clinical examination can be very revealing, including:

  • Breath pause – patients with a breath pause of less than 30 seconds may be suggestive of a disorder

  • Observation – patients displaying upper ribcage breathing and poor diaphragm use may be suggestive of a disorder

  • Breathing rate – optimum breathing is at a rate of 6 cycles per minute, an average patient breathes at around 12 cycles per minute. A rate of more than 15 breaths per minute may be suggestive of a disorder

  • Nijmegen questionnaire – a validated questionnaire, which can be suggestive of a breathing pattern disorder if the patient scores highly

  • Capnography – a specialised piece of equipment that measures carbon dioxide levels and breathing rate

Once a breathing pattern disorder has been diagnosed,it can be subdivided into two categories, intermittent over-breathing (dependent on the situation) or chronic over-breathing. This disorder can be treated, taking an integrated approach:

  • Structural osteopathy – to improve neck function (where the nerve supply to the diaphragm is situated), direct work to the thoracic spine (upper back), rib cage and associated soft tissues, muscles and fascia, helping to improve local mechanics and release tension in the iliopsoas muscle (directly connected to the diaphragm)

  • Breathing re-education

  • Nutritional support

  • Exercise to improve ribcage mechanics, posture, core stability and muscle/fascial flexibility

  • Psychotherapy to look at sub-conscious patterns and situational emotional triggers

  • Capnotraining for chronic over-breathing (in addition to above work)

If you have breathing difficulties, or are unsure whether osteopathy can help, it may be worthwhile coming to see us at Atlas Osteopathy (with clinics in East Finchley and Moorgate, as well as the option of home visits), where we can explain your problems to you, why they occur and whether or not you are suitable for osteopathic treatment. Often this can be done via email or on the phone.

Workout Plan

Tuck your tummy tight and do your crunches like this…

What are the top 2 resolutions people tend to make for a new sporting season or for the New Year? I’d hazard a guess at them being 1) to give up smoking, and 2) to lose weight. A common method by which one or both resolutions can be partially achieved is exercise (I say partially because exercise without a good diet, and vice versa, are proven to be ineffective methods in the long run). Just to throw some more confusion into the mix, exercise is also one of the leading causes of pain, especially low back pain. So what am I getting at here? The importance of balancing different exercises, correct posture and good technique. This blog will look at perfecting the most common exercise, one which people tend to carry out even when doing no other form of exercise, the sit-up.

The starting position for the sit-up is laying on the floor face up, with feet flat on the floor and knees bent at 90 degrees. Feet can be tucked under a firm object only if you do not suffer from low back pain. The initial movement is of the shoulders curling towards the pelvis, with hands gently placed behind the ears. Even as you progress into the sit-up, eyes should be focused on the ceiling and your chin should not touch your chest.

Slowly contract the abdominals and do not pass an angle of 35 degrees(similar to a ‘crunch’) and exhale as you contract the abdominals. Focusing on the abdominals in this way is important, avoiding strain on the neck and hips in particular. The lower back should not leave the floor during the exercise, which will make the sit-up an effective exercise for isolating the abdominals.

Once the 35 degree mark has been reached, hold the position for 2 seconds before gently lowering your body to the floor. Inhale on the way down, and repeat. Continue to focus on the abdominals and on rhythmic breathing as you repeat the exercise.

There are significant errors that it is important to avoid during this exercise: do not place the hands behind the head itself and exert force on the neck during the sit-up as this can cause injury to the muscles and structures in the neck and spine. The hands should lightly support the head, and neck flexor muscles should remain relaxed during the motion. (Here is a good website for further information on sit-ups and other exercises, with an iPhone app available for logging your progress).

So far we have dealt with correct posture and good technique, so what about balancing different exercises? A major cause of low back pain in the active is too much abdominal muscle work, through exercises such as sit-ups, and not enough balancing and strengthening work for the corresponding lower back muscles. This makes the lower back more susceptible to injury and long term low back pain. So what exercises are good for the lower back, acting both as a strengthening and a pain prevention tool? See my next blog!

If you suffer from low back pain, neck pain or other muscular/joint pain issues, or are unsure whether osteopathy can help, it may be worthwhile coming to see us at Atlas Osteopathy (with clinics in East Finchley and Moorgate, as well as the option of home visits), where we can explain your problems to you, why they occur and whether or not you are suitable for osteopathic treatment. Often this can be done via email or on the phone.

Early Onset Pain and Degenerative Change – And the question is, is to have had and lost…

… better than not having at all?

This is a question that commonly arises in sporting individuals who start suffering with joint pain, earlier than expected, or later on in life. And there is no simple answer…

Playing sport regularly from a young age can lead to earlier degenerative changes in the spine and the peripheral joints. I have seen this in Premier League footballers and top 10 tennis players in their early to mid 20s. And this is not exclusive to the elite athletes I have mentioned. Those, like myself, who play football 2-3 times a week (and tennis on the rare occasions when the sun is out) are also more likely to suffer from early degenerative changes.

An example of this can be seen with a female footballer in her mid 20s. She presented with x-rays showing disc degeneration andspondylolisthesis. Such changes in the body are not usually seen until the late 30s and into the 40s. This could be due to the increased loading and pressures applied to the spine and the discs from regular vigorous activity such as playing sport.

However, such degenerative changes may not always be as a consequence of sport. Anatomical variations from birth can also enhance the possibility of early degenerative changes, regardless of the person’s activities. For example, those developing an increased curvature in the lumbar spine (hyperlordosis) are prone to earlier degenerative changes due to the abnormal loading patterns on the disc and spine, which the body was not designed to cope with.

Not everyone is affected in a similar way though, and not everyone will be symptomatic. And testament to this are football players and other sportsmen and women, who have achieved incredible feats well into their 30s and 40s. Another example that comes to mind is that of Sir Steve Redgrave, rowing to another Olympic gold medal, at the age of 38.

So, to try and answer the original question, would one be better off not participating regularly in vigorous sporting activity? Not really… Activity is always better than no activity, which can itself lead to far worse injury and disease through issues such as obesity. It is also not possible to predict who, if undertaking regular sport, would or would not fall foul of early degenerative changes to their body.

There is so much to be achieved in life, and if you were to ask someone like Muhammad Ali whether he would swap the achievements of his boxing career for better health now, the answer would be an emphatic no. We would all have liked to float like a butterfly and sting like a bee…

If you have any aches or pains, or are unsure whether osteopathy can help, it may be worthwhile coming to see us at Atlas Osteopathy (with clinics in East Finchley and Moorgate, as well as the option of home visits), where we can explain your problems to you, why they occur and whether or not you are suitable for osteopathic treatment. Often this can be done via email or on the phone.

Running Injuries

What running injuries present in clinic and why? This article will address three of the most common injuries seen, and give an insight as to why they occur and what can be done to prevent them.

Iliotibial band syndrome (Runner’s knee) – the iliotibial band is a thick sheath of fibrous connective tissue running from the iliac crest (pelvis) to the outer tibia (shin). As the band passes over the lateral femoral condyle (bony prominence just above knee on outer aspect), it is prone to friction as the knee is straightened during running. Pain on the outside of the knee, aggravated by (downhill) running and tightness down the side of the thigh are all symptoms of this condition. The treatment for this begins with rest, cold therapy and stretching of the tight band. Oosteopathic treatment is highly beneficial.

Anterior compartment syndrome (shin splints) – the anterior compartment of the lower leg is a group of muscles housed in a connective tissue sheath. When the muscles become too big for the compartment, this painful syndrome occurs. This can occur due to an impact injury, causing bleeding, a muscle tear, or overuse, all of which lead to swelling. Symptoms include sharp pain on the outside of the leg, muscle tenderness and pain on lifting the foot up. Again, rest, ice and compression (for 20 minutes) are necessary and osteopathic treatment is highly beneficial.

Hamstring muscle strain/tear – the hamstrings are a group of three muscles (biceps femoris, semimembranosus and semitendinosus) which act to bend the knee and extend the hip. A hamstring strain or tear (a Fernando Torres special!) usually occurs during the deceleration phase of running, as you straighten your leg and plant the foot. Osteopathy can once again be highly beneficial. Early commencement of a progressive running program is an important component of rehabilitation following injury, and a generic protocol is outlined below, which should be followed after consultation with your sports osteopath to allow modification as necessary…

  • running program starts 48 hours after injury
  • 10 minutes of gentle hamstring stretching followed by
  • 20 minute running sessions twice a day
  • commences with short stride jogging (“this new fad called ‘jogging’. I believe it’s ‘jogging’ or ‘yogging’. It might be a soft ‘j’. I’m not sure, but apparently you just run for an extended period of time. It’s supposed to be wild…” – Anchorman)
  • increase stride length and pace gradually over session as pain/ache allows
  • interval running over 100 metres, with acceleration, maintenance and deceleration phases
  • if slightest pain in hamstring felt, cease action immediately and ice area (program can be attempted again in just over 12 hours time)
  • finish with gentle hamstring stretching and apply ice to injured area for ten minutes

Whether you are an elite runner, run for fun or just run for the bus, injury can occur and it is important to take action early. If you have a running injury, it may be worthwhile coming to see us at Atlas Osteopathy (with clinics in East Finchley and Moorgate, as well as the option of home visits), where we can explain your problems to you, why they occur and whether or not you are suitable for osteopathic treatment. Often this can be done via email or on the phone.

Work it harder, make it better, do it faster, makes us stronger… Core stability exercises

Core stability exercises are those exercises by which the corset of muscles surrounding the abdomen and back are made stronger. By working these core muscles harder, a more solid base is provided, upon which all other muscles can work upon to initiate movement. Strengthening these muscles is a method by which low back pain can often be reduced and even prevented.

So, what are these core muscles? They are the muscles of the abdominal wall, pelvis, lower back and diaphragm, including the transversus abdominisinternal and external obliquesquadratus lumborum and the diaphragm.

Let’s go through the four main muscle groups in a bit more detail…

Transversus abdominis – the deepest abdominal muscle, found under the rectus abdominis, or ‘ab/six-pack’ muscles. This is the main muscle providing ‘core’ stability. The muscle connects to the individual vertebrae forming the lumbar spine (lower back) and wraps around each side, coming together in the front of the abdomen. When contracted, the muscle increases pressure in the abdomen and pulls the vertebrae tightly together, providing greater spinal stability.

Multifidis – these are the deep back muscles, found on either side of the spine, connecting to each individual lumbar spine vertrebrae. Its function is to aid extension of the back (bending backwards) as well as being an essential postural muscle, helping keep the spine upright, opposing the natural tendency of the body to flex (curl up, as in the foetal position).

Diaphragm – this is the primary muscle used for breathing, providing the ‘roof’ to the core muscles. When the transversus abdominis contracts, the diaphragm tightens, maintaining pressure in the abdomen and providing stability to the spine.

Pelvic floor – provide a sling running from back to front, from the tip of the spine to the front of the pelvis. These muscles contract simultaneously with the transversus abdominis to form the ‘floor’ of the core muscles.

Weakness in these muscles is often the root cause of low back pain. Strengthening the weak muscles and stretching shortened muscles can often relieve this pain. The core is often trained using Pilates or with a Swiss ball exercises.

If you have lower back pain, or any other muscle or joint pain, it may be worthwhile coming to see us at Atlas Osteopathy (with clinics in East Finchley and Moorgate, as well as the option of home visits), where we can explain your problems to you, why they occur and whether or not you are suitable for osteopathic treatment. Often this can be done via email or on the phone.

Sometimes Solutions Aren’t So Simple… Patience, Perseverance and Compliance!

In this day and age, where time is money, people often look for a quick fix solution to their problems. And if results are not achieved yesterday, these people are quick to move on. Sometimes, coming to see an osteopath (or physio, GP etc…) will not be enough by itself, and patience and perseverance is required. Even more essential, however, is compliance.

Osteopathic treatment on its own can often be enough. In many cases, however, what is done by the individual in between treatments is as important as the treatment itself. There are many examples of how poor patient compliance can be damaging to the effect the person is hoping to achieve through seeing an osteopath.

One example is as follows… A person comes to see the osteopath, suffering with neck and upper back pain. The osteopath is likely to advise the person, in between treatments, to carry out stretching and strengthening exercises to aid in the treatment of this condition. The person will be shown how to stretch the tightened front chest muscles, and how to strengthen the weakened upper back muscles. If these exercises are not carried out, treatment will not be as effective, as each week, following treatment, the person will note immediate improvement lasting for a couple of days, then regressing back to original pain patterns. It is, therefore, vital that the person carries out the advice given.

Another example… A person comes to see the osteopath, complaining of pain in the elbow following playing tennis. The osteopath treats the complaint and then advises immediate rest for a few days and to apply ice to the area of the complaint to prevent swelling. Again, this advice is ignored, the pain remains and treatment proves ineffective.

All advice given is to supplement the treatment given by the osteopath in the session. Osteopathy does not itself cure the body of disease and pain. Osteopathy removes the obstacles within the body, preventing it from healing itself. Patient compliance with advice is a key component of this…

If you have any aches and pains, it may be worthwhile coming to see us at Atlas Osteopathy (with clinics in East Finchley and Moorgate, as well as the option of home visits), where we can explain your problems to you, why they occur and whether or not you are suitable for osteopathic treatment. Often this can be done via email or on the phone.

Arthritic Pain… It comes and goes, never the same…

Pain patterns can often be a useful way of determining what is happening with your body and what the cause of your pain and discomfort may be. It is not a definitive diagnosis, simply a method by which factors can be included and excluded to form the correct diagnosis. So what is meant by pain patterns in this article? This is about daily and monthly pain patterns, i.e. when pain is felt, when it gets better or worse, and for what reasons.

The osteopath will often ask what your daily pain pattern is and may ask whether the pain get worse during the day or is it worst in the morning. This is to ascertain what type of condition you may be suffering from. There are, generally speaking, three main groups in to which these conditions are split in to…

Pain and stiffness in morning – these are generally inflammatory conditions such as ankylosing spondylitis and rheumatoid arthritis. Pain is worst in the morning as you will likely have been sedentary laying in bed sleeping for the night. The joints in your body aren’t moving, so the joints can stiffen up and become painful in the morning when you wake up and begin to move about.

Pain and stiffness in evening or after use – these are conditions that cause pain when the joints have been used, and consequently the pain is felt in the afternoon and evening. Conditions such as osteoarthritisand osteoporosis can cause pain after time spent walking and moving, as the joints can become irritated and swollen after use.

Pain that comes and goes or on movement – this type of erratic pain is usually related to movement and is therefore related to muscular or ligamentous pain. Muscular pain will present on movement and is likely to be a sharp pain, whereas ligamentous pain, also on movement or when static in a non-neutral position, will likely be a dull aching pain.

It is therefore useful for both you and your osteopath if you can make a note of your pain patterns so that too much time isn’t spent on your first visit determining these bits of information, which are useful for diagnostic purposes.

If you have any aches and pains, it may be worthwhile coming to see us at Atlas Osteopathy (with clinics in East Finchley and Moorgate, as well as the option of home visits), where we can explain your problems to you, why they occur and whether or not you are suitable for osteopathic treatment. Often this can be done via email or on the phone.

I’ve got a picture of you… X-Ray, MRI, Ultrasound or CT!

Osteopaths, like doctors, will often need as much information as possible in order to get a diagnosis, when clinical examination on its own has not provided sufficient answers. For instance, a person may present with low back pain that does not follow one of these common patterns:

pain on flexion (bending forward) – which usually indicates a problem with the disc, and a possible disc bulge

pain on extension (bending backward) – which usually indicates a problem with the vertebrae, and a possible spondylolisthesis (forward slippage of one vertebra over another)

and so on…

Therefore, the use of medical imaging is often necessary. This may not be the first port of call. Initially, most osteopaths will give a period of 6 weeks from your initial presentation before requesting imaging, if there has been no improvement in symptoms. This would mean that the diagnosis may not be correct, and so treatment is currently proving to be ineffective.

So what imaging will be requested, and why? And how much does this all cost? Well depending on the presenting problem, the imaging technique will be one of:

x-ray – useful for looking at bone structure and suspected fractures (~£100)

MRI scan – useful for looking at soft tissues in detail, so an MRI of the spine would be requested instead of an x-ray if, for example, a disc bulge was suspected (~£200-600)

ultrasound scan – high resolution, dynamic assessment of soft tissues, can be used for guided interventions, such as injections, and is more detailed for looking at local anatomy compared to the more global outlook of an MRI (~£200)

CT scan – enhanced detail of bone pathology, useful for interventions such as injections (~£400)

These images are then reported by specialist radiologists and the reports will details what has been found by the scan and possible reasons for these occurrences. This will then give the osteopath a better picture of how to continue with treatment. The osteopath may be able to describe the images to you and will be able to explain the reports of the doctors to you in more detail if necessary. Hopefully this will help you understand why imaging is necessary, and what you can expect.

If you would like your scans and reports to be explained to you, or if you have any aches and pains, it may be worthwhile coming to see us at Atlas Osteopathy (with clinics in East Finchley and Moorgate, as well as the option of home visits), where we can explain your problems to you, why they occur and whether or not you are suitable for osteopathic treatment. Often this can be done via email or on the phone.

Sleep, find your peace…

The average life expectancy in the UK has risen once again, and as of the 2012-14 data, a newborn baby boy can expect to live to just over 79 years old, and a newborn baby girl to just under 83. When you imagine that you’ll be asleep for roughly a third of your life, if you stick to the recommended 8 hours a night’s sleep, those approximately 27 years will need to be spent sleeping in a good position. This is easier said than done in some cases, as the ideal sleeping position to prevent issues such as backache can vary depending on your status. Our osteopath, Hashim says:

“In order to prevent back pain in bed, taking care of your posture is essential. I usually recommend my patients, who are otherwise healthy, to sleep on their right hand side, with knees bent up slightly. Laying on the right hand side is good for blood flow, as you have the smaller and lighter left lung resting on the heart in this position, maximising blood flow. It is important to ensure that the gap in between the shoulder, neck and head is filled with pillow, so that the spine and neck remain in good alignment. Imagine how your neck sits vertically in line with the rest of the spine when you are sitting and standing; when you are laying on your side, you want to maintain that. Pillow depth is key, the firmness or softness is personal preference. A good mattress goes a long way to prevent pain as well, because if it isn’t supporting your spine, it will be allowing the spine to spend long periods in poor and unhealthy positions. If for other medical reasons, such as acid reflux for example, you have been advised to lay on your back, have the head slightly raised, but a much shallower pillow than described above, as once again, we do not want the neck under strain.”

“In the morning and evening I always find it beneficial for people to ‘warm up’ and ‘warm down’ from the busy days they will have had. To achieve this, some gentle stretching will help, particularly for the neck, lower back and hamstrings muscles. For the neck and lower back, gentle stretching in all vectors of movement (bending forwards, backwards, to the sides, and in rotation) will help, ensuring you engage the core muscles at all times to strengthen them and stretch the other muscles. For the hamstrings, having one leg up on the bed and gently stretching forward until you feel a stretch down the back of the leg will help, particularly if you have been sat down all day as the hamstrings will have been contracted and shortened for that whole period, they deserve a stretch!”

If you are having trouble sleeping, or have anything to ask regarding what to change, it may be worthwhile coming to see us at Atlas Osteopathy (with clinics in East Finchley and Moorgate, as well as the option of home visits), where we can explain your problems to you, why they occur and whether or not you are suitable for osteopathic treatment. Often this can be done via email or on the phone.