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.

You Don’t Need This Disease…

Hygiene is one of the easiest and perhaps most important aspect of healthcare to take care of. There are many precautions that can easily be taken to minimise and reduce the spread of infection from person to person. Personal hygiene is something everyone should take pride in, for their own sake, and for others around. In medicine and healthcare, hygiene practices are employed as preventative measures against the incidence and spread of disease.

Hand hygiene and respiratory hygiene are, in the osteopathic clinical setting, two of the more important topics. Hand hygiene would be defined as washing the hands with the use of soap and water, or hand sanitiser. This is paramount to the prevention of infectious disease spreading.

six stage handwashing technique (Ayliffe et al, 1978) is the best known method of ensuring hand hygiene. The technique involves rubbing palm to palm, backs of both hands, palm to palm with fingers interlaced, rubbing both palms with fingertips of other hand, rubbing all parts of both hands including the wrists and finally rubbing the backs of fingers with them being interlocked. Each stage should consist of five backward and forward strokes. This may seem tedious and time consuming, but should not take more than a minute, and is vitally important in the prevention of disease spreading.

Respiratory hygiene is also linked to hand hygiene when coughing and sneezing, to reduce the spread of germs, particularly in the cold and flu season. Tissues should be carried to catch germs when sneezing, with disposal of tissues immediately after use, followed by washing hands with technique outlined above.

Osteopaths themselves take particular precautions, both for self-preservation and for patient protection. These include the washing of hands before and after each patient, fresh sheets and towels for each patient, and the daily use of new and clean uniform. Personal protection is always worn when there is a risk of coming into contact with bodily fluids, such as a cut or graze on the body.

Sunshine and Vitamin D – How winter can be more than just cold!

One day like this a year’d see me right…

Sunshine is a rarity around this part of the world, especially for my friends up in Scotland. It is, therefore, imperative that we all make good use of the sunlight while it is around us. Why? The body makes vitamin D when exposed to ultraviolet B (UVB) rays from the sunlight. The benefits of vitamin D are many, with it promoting the absorption of calcium and phosphate from food intake, and is essential in the formation of bones and teeth.

Vitamin D has also been found a vital nutrient to help control asthma, prevent high blood pressure, multiple sclerosis and ward off Parkinson’s disease. A deficiency in vitamin D can lead to a failure of the bones to grow, and causes rickets in children and osteomalacia in adults.

Vitamin D is also believed to play an important role in regulating cell production, that may have an effect on reducing breast, colon and prostate cancers. Lack of vitamin D can also lead to lower lung function which means lesser control over an asthma attack. The nutrient also plays a role in strengthening nerve cells, which get affected in Parkinson’s disease.

Most vitamin D is made by the body when the skin is exposed to sunlight, although some comes from oily fish (tuna and salmon), milk and cereal. Vitamin D supplements can also be taken. Although sunlight is the main source of vitamin D production, exposure is also a risk for skin cancer, and you are advised to use sunscreen after a few minutes in the sun. The amount of exposure required to generate adequate vitamin D also depends on where in the world you live, and what time of year it is.

It goes without saying that you will need extra sources of vitamin D in the winter months other than sunlight, especially if living in the most northern parts of the northern hemisphere. The intensity of UVB rays is also reduced by clouds, pollution and glass, so sitting next to a window will not provide enough sunlight to make vitamin D.

As previously mentioned, increased exposure to sunlight can increase the risk of skin cancer. The use of sunbeds can also cause skin cancer. Both sunbeds and the sun emit UV rays (UVA and UVB), that penetrate deep into cells and can cause gene damage, triggering skin cancer. Many experts support the notion that sunbeds should not be used as a method of tanning.

If you would like advice on nutrition, 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.

Compression Socks – What is the fuss all about?

If it’s a 7 hour flight or a 45 minute drive…

Long distance travel can be a luxury and a wonderful experience, if you have plenty of money to throw about and travel in style. If, like most of us, you are not so fortunate, it is important to develop good habits and take care of one’s posture. According to research carried out by myself and Evexar Compression Advisory Ltd, the average person travels for around 400 hours a year, the majority via car, including an average of 10 hours a year on a plane.

There are two main issues that can cause problems when travelling seated for long periods of time, low back pain and ankle swelling. Why do these occur? Let’s start with low back pain…

The human spine was designed to balance stability and mobility, allowing us to move, whilst keeping us in one piece. When the spine is immobilised for long periods of time, such as when sat in the car or on a plane for over an hour, forces through the spine concentrate onto one particular area, in the lower back. This excessive force causes strain to the intervertebral discs. The spine goes from an ideal posture, to a poor, pain-causing posture. The use of a lumbar support cushion, or lumbar spine brace/belt can aid in the prevention of low back pain. Alternatively, if possible, it is important to get up, move about and stretch both the back and the legs, which can help a person avoid the second problem of ankle swelling and its’ complications.

Any prolonged time spent sitting down will reduce blood flow back to the heart, known as venous return. This will cause blood to pool in the lower limbs, visibly seen as ankle swelling or oedema. This why following a long-haul flight, many of us will notice swollen ankles when we take our socks and shoes off on arrival. This ankle swelling also increases the risk of forming a blood clot or deep vein thrombosis (DVT), which is a blood clot in the deep veins of the leg. This is because the rate of blood flow slows down, increasing the chance of the blood clotting, and logically, the longer the seated, inactive period, the greater the risk of a DVT occurring. DVT also has complications in itself, with the risk that the blood clot may dislodge, travel back towards the heart, blocking a blood vessel on its way, or potentially in the lungs, which is fatal. Therefore prevention of such occurrences is very important, and a few methods are outlined below.

DVT can potentially be caused by dehydration, but more likely by immobilisation. Therefore, it is important to increase water intake and decrease alcohol and caffeine intake when travelling. Leg, particularly calf muscle, contraction exercises are important to increase blood flow back to the heart. Compression socks have been found beneficial in studies with regard to promotion of venous return and DVT prevention after surgery and after travel.

If you are about to travel or have suffered with low back pain/ankle swelling in the past, 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.

What to Expect when Visiting an Osteopath… And some Insurance Details!

And I will try to fix you…

Many conditions can benefit from osteopathic treatment, such as neck and back pain, shoulder and arm problems, pelvis, hip and leg problems, sports and other injuries. Whether you are sat at a desk for over 8 hours a day, or training for the marathon, osteopathy is the holistic approach to the treatment of a variety of conditions.

So, what can be expected when visiting an osteopath? In the first instance, it should be explained to the patient what osteopathy is, a holistic approach to the treatment of mainly, but not exclusively, musculoskeletal complaints (muscle, bone, joint pains). You will be informed that you may have to undress down to underwear depending on your presenting complaint, as you would with any other medical examination.

A detailed case history will then be taken, giving the osteopath all the information they need in order to accurately examine, diagnose and treat the problems found. This will include information on presenting complaint, previous episodes and past medical history. This level of detail is required for the previously mentioned reasons, and so that any correspondence needing to be made with your other healthcare practitioners and insurers can be done so, with your permission.

Having assessed the individual, and having treated and reassessed at the end of this first consultation, the osteopath can then give a prognosis, telling the person how long and how many treatments they expect it will take for the problems to be resolved. Osteopathy does not claim to cure people, it aims to remove any obstacles within the body, preventing the body from healing itself. Therefore if progress is not made as expected, usually within 4-6 weeks, further assistance may be required, such as the use of imaging (x-ray, MRI).

It is, therefore, never possible to predict exactly how many treatments it will take to treat and resolve a problem. Osteopaths are generally unlikely to say you need 10 treatments over 10 weeks at £XXX, as is the case with the majority of chiropractors. The guarantee that our osteopathy can make is that we will give our maximum effort and aim to successfully conclude treatment with the minimum sessions necessary, saving the person time and money. Osteopathy is also available on the majority of private health insurances (AXA PPP, Aviva, Pru Health, Simply Health etc), but we would advise you call them to check your policy first.

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.

New Year, New You… Coping with Osteoporosis

My body is aching, feels like it’s wearing me…

Osteoporosis is a progressive condition characterised by a decrease in bone mineral density (BMD). This occurs naturally, as the balance between bone being broken down and reformed, shifts. At a younger age, bone is broken down but reformed at a greater rate. As you get older, bone is broken down at a greater rate than is reformed, leading to a reduced BMD. This increases the risk of osteoporosis, and can be prevented by maintaining levels of calcium and vitamin D.

The condition can be asymptomatic at first, and can remain so. However, if pain starts, osteoporotic pain is usually a dull aching bone pain, which can become sharp on movement. The decrease in BMD can cause fractures to occur at a lesser force than would otherwise normally be required in healthy bone. These fractures are most common in the wrist, hip and spine. In the spine, these fractures are known as crush fractures. The condition will usually cause an increase in pain on standing and walking.

Individuals are at an increased risk of osteoporosis if there is a family history of the condition, an insufficient dietary intake of calcium, a sedentary lifestyle and if underweight. Those of a white or Asian background are also at an increased risk, as are people who have been using drugs or corticosteroids, cigarettes and alcohol for long periods. Women who have had an early menopause are also at an increased risk of developing osteoporosis.

Having a diet rich in calcium is important, as are avoiding smoking and alcohol in order to prevent osteoporosis occurring. Once the condition has developed, weight-bearing exercises are necessary to increase BMD. With women, oestrogen replacement therapy can also aid in preventing osteoporotic symptoms worsening.

If you are having dull pain in your bones or muscles, or have any muscular 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, as well as advising on a healthy lifestyle and exercises that will be beneficial to BMD. Often this can be done via email or on the phone.

Nature’s Law – ‘Management of Degenerative Changes’

You should never fight your feelings, when your very bones believe them…

… you have to follow nature’s law.

This dictates that with the passing of time, our bodies get older, and with this ageing process come inevitable changes that cannot be fought. Instead it is important to understand these changes and learn how we can help ourselves.

Often the phrase ‘degenerative changes’ is used by health professionals when describing why someone has back pain or knee pain. What does this mean? This refers to osteoarthritis, which is a degenerative condition or joint disease. It is most common in the neck and lower back, followed by peripheral joints such as the knees.

In osteoarthritis of the spine, the spaces between the vertebrae narrow, and bone spurs can often form as the pressure on the vertebrae increases, so new bone is laid down to help distribute the pressure. However, these bone spurs (osteophytes) can impinge on spinal nerves, causing shooting pain on movement as the nerve is compressed. When the bony surfaces rub together, such as at the facet joints, the area can become inflamed and painful. Gradually, the spine stiffens and loses its flexibility.

Similarly, osteoarthritis can affect joints like the knee joint. This begins with damage to a structure in the knee, such as the meniscus, which serves as a shock absorber during activity such as running. This tissue damage causes the body to attempt repair, but during this repair, inflammatory cells are released which damage the cartilage in the joint. The process of osteoarthritis then begins.

So what can be done to ease the problems associated with osteoarthritis? Freeing up stiffened joints is one of the most effective ways of managing osteoarthritic pain and reducing disability as a result of the condition. Reducing tension in the muscles around the affected joint can aid in reducing pain and inflammation too. Exercises can also be prescribed to help the person help them self, as treatment will provide relief and help, but self-maintenance is just as important in the days between seeing the clinician.

If you are having pain and feeling stiffness, or have any muscular or joint pain or stiffness, 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.

Winter Blues… Joint Aches and Pains

My bones ache, my skin feels cold…

There are conditions affecting the body that can flare up in cold weather, and with winter approaching soon, it is important to understand what can be done to ease the symptoms of these flare ups.

Pain when getting out of bed in the morning, or when picking up a child are not necessarily an inevitable consequence of the ageing process. Often people will give up activities that are dear to them due to the pain they feel. In cold weather, this pain/ache/stiffness can be exacerbated. In cold weather, joints in the extremities (arms and legs) do not receive as healthy a blood supply as in warm weather. Pain receptors are also more sensitive in cold weather, and a drop in barometric pressure can cause inflamed tissues to expand and become even more painful.

Joints are formed when two bones meet, connected together by strong bands called ligaments. Muscles attach to the bones by bands called tendons, and the muscles facilitate movement of the body. Healthy joints are surrounded by a joint capsule, and gaps in the joint are filled by fluid-filled sacs called bursae. Within the joint capsule, the bones are lined by a smooth cartilage and synovium that serve to protect the joint and reduce friction during movement.

The two main types of inflammatory conditions commonly known to flare up in cold weather are osteoarthritis (OA) and rheumatoid arthritis (RA). OA is the type of arthritis that gets worse as the day progresses, and as the joint is used more. The inflammation generally occurs as a result of cartilage degeneration. RA is an autoimmune disease characterised by chronic pain and stiffness in the peripheral joints, worst in the morning and can last throughout the night. With this type of arthritis, the pain generally eases with use of the joint.

Now the question is, what can be done to manage and potentially reduce the inflammation and pain? In cold weather, it is more important to wrap up and wear extra layers, especially protecting the hands and feet with gloves and extra socks. Aside from this, it is important to control diet, with particular regard to ‘inflammatory’ foods. This involves reducing the intake of fried foods, red meat, saturated fats, soft drinks, fruit juices and sugars. Instead of these, it is recommended to consume dark green vegetables, vitamins C and E, raw nuts and seeds, omega-3 rich fish and soups made from raw ingredients. The avoidance of ready-made packaged meals is important!

If you are having arthritic pain and flare ups associated with this, or have any muscular or joint pain or stiffness, 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.