Aches & Pains
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In the UK a third of the population are suffering with back pain and up to 80% of the adult population will suffer significant back pain at some time in their life. Back pain may be referred to the hip, groin, buttocks, the leg and foot as sciatica. The main causes of most low back pain are muscular weakness and postural strain due to being overweight, sitting too much, lack of exercise, unequal leg-length, trauma or over-exercise. Sometimes it is the cushion between the bones (intervertebral disc) which bulges (herniates) and compresses spinal nerves. As osteopaths we are specialised in diagnosis of all forms of low back pain and sciatica, using our thorough spinal and clinical examination. Testing your joints, ligaments, tendons and muscles and using neurological tests of your reflexes, sensation and muscular strength all helps to make an accurate diagnosis of your specific problem. We treat back pain and sciatica using specific joint manipulation or mobilisation, soft tissue and massage techniques, together with exercise and nutritional advice.
Most acute back pain is mechanical in nature - the result of trauma to the lower back.
Pain from trauma may be caused by a sports injury, work around the house or garden, a sudden jolt from a car accident or repetitive stress to spinal joints and musculature.
Symptoms may range from muscle aches to shooting or stabbing pain, spinal stiffness or an inability to stand upright.
Chronic back pain is one that persists for more than 3 months.
It is important to diagnose and treat chronic problems sooner rather than later to avoid further gradual degeneration of spinal joints.
Its cause is usually similar to acute back pain, however the presence of osteoarthritis / degenerative conditions and postural / occupational factors may have an important role to play here.
The back is an intricate structure of bones, joints, muscles and other tissues that form the posterior part of the body's trunk, from the neck to the pelvis.
The centrepiece is the spinal column, which not only supports the upper body's weight but houses and protects the spinal cord - the delicate nervous system structure that carries signals which control the body's movements and convey its sensations.
Small nerves enter and exit from the spinal cord through spaces between the vertebrae.
The spaces between the vertebrae are maintained by round, spongy pads of cartilage called intervertebral discs. These allow flexibility of the back and act like shock absorbers throughout the spinal column to cushion the bones as the body moves.
Strong ligaments and tendons hold the vertebrae in place and attach the muscles to the spinal column
As people age, their bone strength, muscle elasticity and tone tend to decrease. The discs lose fluid and flexibility which decreases their ability to cushion the vertebrae.
Pain can occur when you lift something too heavy or overstretch, causing a joint sprain or a spasm in one of the muscle groups in the back. A disc may rupture or bulge outward; this can put pressure on spinal nerves. When these nerve roots become compressed or irritated, back pain and ‘sciatica’ often occur.
Low back pain may result from nerve or muscle irritation, joint sprain or bone lesions. Most low back pain follows injury or trauma to the back, but pain may be associated with other factors such as degenerative conditions – arthritis, bone or disc disease, osteoporosis or congenital abnormalities of the spine.
Obesity, lack of exercise, pregnancy, stress, poor physical condition, poor posture and poor sleeping position also may contribute to back pain.
Additionally, scar tissue created when an injured back heals itself does not have the strength or flexibility of normal tissue.
A build-up of scar tissue from repeated injuries eventually weakens the back and can lead to loss of normal flexibility and function.
Occasionally, low back pain may indicate a more serious medical problem. Pain accompanied by fever or loss of bowel or bladder control, pain when coughing and progressive weakness in the legs may indicate a severely compressed nerve or other serious conditions.
If you are suffering from any of the above please contact your GP urgently.
Sciatica is a condition in which a herniated or ruptured disc presses on the sciatic nerve, the large nerve that extends down from the lower back to its exit point in the pelvis and carries nerve fibres to the leg.
Sciatic nerve compression causes shock-like or burning low back pain combined with pain through the buttocks and down one leg to below the knee, occasionally reaching the foot.
In the more severe cases, the symptoms involve not only pain but numbness and tingling with occasional loss of muscular control in the leg
Disc wear and tear can lead to a narrowing of the spinal canal especially if the spine has become twisted (scoliosis)
A person with spinal degeneration may experience stiffness in the back on waking and leg pain (sciatica) during walking or while standing for a long time.
Specific and careful osteopathic treatment may help alleviate postural stress due to degenerative change and help alleviate symptoms.
Osteoporosis is a metabolic bone disease marked by progressive decrease in bone density and strength. Women are four times more likely than men to develop osteoporosis – especially after the menopause. Fracture of brittle bones in the spine and hips results when this condition is allowed to advance untreated.
Skeletal irregularities and abnormal posture produce strain on the supporting structures of the spine. These irregularities include scoliosis, a curve or series of curves of the spine to the side; kyphosis, in which the normal curve of the upper back is severely rounded; lordosis, an abnormally accentuated forward sway in the lower back or neck.
Gentle osteopathic treatment together with regular exercises can often help to straighten and mobilise curvatures and minimise spinal pain and stiffness.
Spondylosis refers to chronic spinal degeneration and stiffness, whilst spondylitis describes inflammation of the spinal joints.
Another painful inflammatory condition of the lower back is sacroilitis (inflammation in the pelvic joints).
Spinal X-rays may help diagnose the cause and location of back pain and screen for more serious pathology.
MRI (magnetic resonance imaging) is more useful in evaluating the spine for bony degeneration, disc damage and nerve entrapment as it visualises soft tissue as well as bone
At the right point in your recovery, exercise is the best way to help yourself strengthen your low back by rebuilding lost muscle tone and strength.
Maintaining and building spinal and abdominal muscle strength is particularly important for people recovering from a spinal injury.
We can provide a list of gentle exercises which help keep muscles moving and speed the recovery process. A routine of back-healthy activities may include stretching exercises, swimming, walking, and cycling to improve coordination and develop better posture and muscle balance.
Pilates and yoga are excellent means to gently stretch and strengthen muscles and ease pain.
Medication is often used to treat acute and chronic low back pain.
Anti inflammatory medication is most effective in the acute phase of most muscular-skeletal conditions but long term use is not recommended.
Spinal manipulation is an effective, proven and safe "hands-on" approach in which a professionally registered practitioner will use specific spinal manipulation together with soft tissue and other complimentary techniques, to improve spinal structure and function
Neck pain can be caused by sudden physical injury to the spine resulting in trapped nerves or disc damage between the vertebrae, with accompanying muscle spasms.
It can also be more chronic in nature - occupational, postural, and arthritic conditions all being factors to consider. The sudden intensity of 'acute neck pain' can be due to a locked facet joint or a trapped nerve
This may cause protective muscle spasm and referred pain to the head, shoulder, and upper middle-back (between the shoulder blades) or into the arm, depending on which nerve or tissue is inflamed.
Trauma, anxiety, awkward sleeping positions and prolonged, poor posture at computer keyboards are often to blame. Pain lasting longer than three months is regarded as being 'chronic' neck pain.
There may be underlying problems such as 'slipped' or bulging discs, osteoporosis (brittle bones), scoliosis (excessive curvature of the spine) and, very rarely, structural damage due to serious pathology (tumours, meningitis etc.)
Car accidents involving whiplash injury can result in acute or chronic neck pain which takes many months to improve.
Occasionally acute pain can be caused by ‘torticollis’, an abnormal neck posture where the head is forced to one side by protective muscle spasm; it often presents with weakness in the shoulder or arm and with occasional tingling into the arm or fingers. It is most commonly a condition that is present on waking for no apparent reason.
Fibromyalgia is a chronic musculo-skeletal disorder characterized by widespread pain, fatigue, and multiple ‘tender points’, particularly felt in the neck and shoulder areas, although the pelvic and lumbar areas may also be involved.
Additional symptoms may include sleep disturbances, morning stiffness, bowel sensitivity and anxiety.
We will carry out a full osteopathic assessment of muscle tone, posture and spinal joint mobility, a neurological examination of reflexes, strength and sensation.
We will relate this to any relevant occupational and social factors along with any pre existing problems which may be relevant to the condition.
MRI scans may be requested if considered clinically important.
Osteoarthritis is the most common form of arthritis affecting 8 million people in the UK alone.
It is commonly caused by wear and tear and its prevalence increases with age.
It is mainly characterised by damage to the cartilage which covers the end of the bones and particularly affects the joints that get heavy use, like hips, knees and spine. It also often affects the base of the thumb and big toe joint.
Factors that increase your risk of osteoarthritis can be previous injury, which means any age group can be predisposed to OA, genetics, occupation/leisure activities which are physically demanding and repetitive, hypermobility and obesity.
Rheumatoid arthritis affects more than 400,000 people in the UK. It usually starts around the age of 40-50 and women are three times more likely to be affected than men.
Rheumatoid arthritis occurs when the body’s immune system attacks healthy joints which leads to pain and swelling. It can cause a change in the shape of the joint. People with rheumatoid arthritis can also develop problems with other tissues and organs in their body.
Factors that increase your risk of rheumatoid arthritis can be your sex, age, family history, smoking, environmental exposures and obesity.
With inflammatory arthritis there’s likely to be more swelling of the joints and more variation in the pain (which can't be explained simply by the level of physical activity)
As osteopaths, we can help by using a variety of techniques such as soft tissue massage and gentle mobilisation of the joint, that will improve movement and reduce swelling which in turn will reduce pain
Surgery may be necessary and advisable if the damage to your joint is severe enough to cause difficulties in your everyday life, and when other treatment isn’t reducing the pain. Joint replacements are now very sophisticated and successful. Your osteopath will discuss this with you if necessary
Most everyday activities involve use of our arms and shoulders and in order to allow you normal use, the shoulder joint is designed to be very flexible.
It is therefore very important that the muscles supporting the shoulder remain strong and flexible enough to prevent it from becoming inflamed and painful.
Common conditions of the shoulder, such as tendonitis, frozen shoulder, muscle strain and arthritis can be successfully treated by osteopaths using a combination of hands on treatment and exercises.
Frozen shoulder or 'adhesive capsulitis' is a condition which affects shoulder joint mobility with debilitating pain and stiffness.
It primarily effects people aged between 40 and 60 and classically develops over a period of several weeks or months after a trauma to the joint.
If left untreated, recovery can be slow and symptoms can last for two to three years.
Diagnosis is relatively simple, usually from patient history and clinical examination. X-ray or MRI are rarely necessary to confirm its presence
Tennis elbow (or lateral epicondylitis) affects nearly half of all tennis players at some point, although tennis actually accounts for less than 5 percent of all reported cases.
Golfer’s elbow (or medial epicondylitis) is similar to tennis elbow but pain and tenderness are felt on the inside (medial aspect) of the elbow, on or around the joint's bony prominence.
Recurring pain on the outside of the upper forearm just below the bend of the elbow; occasionally, pain radiates down the arm towards the wrist.
Pain caused by lifting, rotating or bending the arm or grasping even light objects, such as a coffee cup.
Difficulty extending the forearm fully (because of inflamed muscles, tendons and ligaments).
Pain that typically lasts for 6 to 12 weeks; the discomfort can continue for as little as 3 weeks or as long as several years
Everyday stresses and strains, dictated by our busy lifestyles, can lead to a gradual build up of tension and overuse in our muscles, tendons and joints. Sometimes when this reaches its peak we will experience pain and disability
Repetitive Strain Injuries are common in areas where our muscles and tendons are used to carry out the same, repetitive function over and over without rest – often in an area where the natural activity patterns of these muscle groups are designed to function in a very different way to that which is necessitated by modern computer keyboards etc.
The muscle tendons become inflamed and swollen where they run through their tendon sheaths or pulleys and this sets up a chronic pattern of pain and dysfunction in the affected areas.
Often labelled tendonitis, tenosynovitis or epicondylitis these conditions are all characterised by localised pain and swelling and if left to become chronic, normal function and dexterity may become severely compromised
An initial examination of the painful area will look for tenderness and swelling, symptomatic of conditions such as tenosynovitis or epicondylitis.
We will also thoroughly examine related areas of the spine, muscular and nervous systems which are often implicated as predisposing factors in the establishment of RSI.
Once a diagnosis has been established following orthopaedic and neurological testing, mobilisation and deep tissue massage aim to improve posture, stop pain and restore strength and mobility.
We help you eliminate as many of the contributory causes of the problem as possible with advice on height of computer screens and workstations, ergonomic seating, writing slopes, beds and car seats.
We may also prescribe regular corrective exercises to regain strength and stamina and help combat the pain.
Osteopathic assessment and treatment of involved muscles, ligaments and tendons may involve soft-tissue massage therapy, exercises and hot / cold therapy as well as manipulative treatment of the neck & shoulders.
Sciatica is specifically nerve pain which can radiate, giving symptoms down the posterior aspect of either leg, from the thigh, through the calf and into the foot.
This pain is caused by irritation or compression of the sciatic nerve, where its nerve roots or branches exit through several small openings between the lumbar vertebrae.
There may be numbness and weakness of the lower leg muscles and loss of reflexes.
Sciatica (compression of part of the sciatic nerve resulting in leg pain etc.) is often combined with low back pain. The order in which the symptoms appear may vary. Back pain often precedes sciatica but this is not always the case.
The most common cause of true ‘acute’ sciatica is a ‘slipped’ (prolapsed, herniated or bulging) disc.
The discs (inter-vertebral discs) are the cushions which separate the bones of the spine (vertebrae).
The bulging disc causes the nerve root to become compressed where it exits the spine by squashing it against the adjacent bony structure.
This causes a decrease in the nerve’s ability to conduct properly – resulting in pain, tingling, numbness, or loss of muscular control (in order of increasing severity)
Other causes may include; bony degeneration, arthritis, osteoporosis, spondylolisthesis or a tumour of either bone or nerve.
Sciatica may cause the sufferer’s posture to be distorted – by bending forward or sideways in an attempt to avoid further nerve compression and pain.
Osteopathic treatment is very effective in resolving the majority of cases, by helping reduce the irritation of the nerve using a variety of treatment techniques, exercises and postural advice.
When clinical examination indicates the possibility of a large disc prolapse with major neurological signs and symptoms, a private MRI scan can be arranged quickly.
Chronic ‘tension headache’ is the most common form of headache that we treat in clinical practice.
It originates just below the base of the skull due to mechanical dysfunction and chronic stiffness in the joints and muscles of the upper neck.
This in turn leads to irritation of the nerves which supply the occipital – frontal areas of the skull.
Pain is felt as a dull thumping headache which responds poorly to pain killers.
Cervical spondylosis, (various forms of wear and tear) spondylitis, and rheumatoid arthritis.
Trigger points in the neck and shoulder muscles together with poor posture and neck position at work or during sleep.
Pain classically starts in the occipital region at the base of the skull and spreads over the vertex to the forehead, temple and eye. Intensity fluctuates from mild or moderate to severe and can occur daily and be worsened by head and neck movement.
Vertigo / dizziness
Not all cases of dizziness or vertigo originate in the balance mechanisms of the inner ear or are due to circulatory pathology (disruption of normal blood flow to the brain).
Nerve receptors in the cervical spine joints and supporting muscles are also very important in the maintenance of normal balance.
Patients experiencing dizziness relating to a mechanical imbalance in the neck may feel positional unsteadiness or giddiness with a feeling that the ground is moving, postural instability on turning the head and imbalance that is markedly worsened by sudden head movements such as looking up or down.
Neck pain is nearly always present with muscle tenderness, stiffness, and guarding of the cervical region.
These symptoms may often precede the sensations of dizziness by days or weeks.
In all cases of head pain or dizziness it is vitally important to carry out a thorough examination to determine the most likely cause of the symptoms and rule out the possibility of the presence of serious pathology.
We will take a full history of your headaches and general medical history and perform a physical and neurological examination before making a diagnosis and proceeding with treatment.
If at any stage we are unhappy with our clinical findings, we will either refer you back to your GP or arrange further diagnostic tests such as MRI or X-ray.
If you suffer a headache that is of sudden unexplained onset and severe in it’s intensity, accompanies a fever, stiff neck, rash, confusion, seizure, double vision, weakness, numbness, difficulty speaking or follows a head injury please seek medical treatment urgently as this may constitute a medical emergency.
More and more people are taking part in both recreational and competitive sports to improve their health and general well being.
From time to time sportsmen and women develop problems due to either a single traumatic incident or to minor repetitive strain.
You do not need to put up with ongoing pain as part of your activity.
We can usually quickly identify the underlying cause of your injury and deliver effective treatment to help you return to your sport quickly and safely without risk of recurrence.
We have treated all forms of sporting injuries; from those associated with occasional leisure orientated exercise, running, swimming, football, rugby, tennis, squash, golf etc through to more specific problems associated with triathletes, climbers, windsurfers, skiers and competitive cyclists.
Running, athletics, dance and competitive sports place a great demand on an athlete's feet, legs, spine and entire body.
Many common conditions affecting dancers and runners include: tendonitis, bursitis, shin splints, ankle and achilles tendon problems.
Sometimes incorrect equipment can lead to injury - poorly fitting footwear will often lead to hip, knee and foot injuries.
Young people are especially vulnerable in sport, as their growing bodies are often subjected to exceptional physical demands.
The good news is that although sports injuries are common, those who are fit tend to recover more quickly and easily from their injuries.
We diagnosis, provide effective treatment and offer sensible advice to help you come to terms with your injury, resolve the problems it has caused and reduce the likelihood of recurrence.
Treatment will include soft-tissue manipulation, joint mobilisation and massage techniques, as necessary, to achieve optimal results.
If indicated, we can refer you for X-ray or MRI scan of the damaged area should we suspect the presence of stress-fracture or underlying bone disease.
As the number of hours spent working at computers has steadily increased, so has the number of posture related conditions that we see on a daily basis in our practice.
The pain caused by poor postural habits (whether at work, in the car, or at home) manifests itself primarily in the muscles of the neck, shoulders and low back, but can also – either directly or indirectly, affect many other parts of the body.
Whilst manual work inevitably carries the inherent risk of back injury from a combination of heavy and often awkward lifting, as well as periods of prolonged bending, it is in the office, where desk work is more common, that the dangers of ‘computer hump’ and ‘mouse wrist’ await; whilst long hours on the telephone will affect the neck and shoulders causing headaches and carpal tunnel syndrome etc.
Those who drive for a living also need to be aware of their driving posture as it affects not only their back, neck and shoulders but can also affect hips, knees and feet.
Osteopathy can help to alleviate postural pain by treating the stiffness of the affected muscles and joints.
We help to improve posture by eradicating the chronic muscle imbalance that has slowly built up over the months or years, with graduated stretching and strengthening exercises.
Osteopathic treatment through pregnancy (and after birth) is a gentle way of reliving the stresses and strains on the body, by helping you to adapt to the many postural changes that take place during this time. These changes can also lead to additional pressures on various parts of the body not just the spine and pelvis.
Treatment during pregnancy requires a little extra care, and we would avoid all joint manipulation for the first 12 weeks of pregnancy, referring you straight back to your doctor or midwife if we have any concerns.
Osteopathic treatment during pregnancy is not new. For many years, osteopaths have used their skills to help, employing a variety of gentle techniques to ease the supporting muscles and ligaments of the body to make the whole experience considerably more comfortable. Self management and exercise advice can also be given.
Where does it hurt?
Advice from your osteopath can help you to change your posture and learn to use your body more efficiently throughout your pregnancy and beyond.
Osteopathy can help to relieve:
• Low back and leg pain
• Pelvic pain
• Neck and shoulder pain
• Wrist pain
• and more.
After the birth
After childbirth, it is not uncommon to be left with some residual aches and pains from the changes that happened to your body whilst pregnant. We can also give postural advice related to breast feeding.
A check up two to three months after childbirth is always recommended as part of a rehabilitative programme, supplemented by exercises and other forms of self help which the osteopath may prescribe to help you recover your muscle tone and strength to their previous state.
If you have medical insurance, osteopathic treatment should be covered in the normal way. If you wish to use your insurance it is important to contact your insurer before treatment as they may require you to see your GP first.