Osteopathy - Better than Diazepam

Here’s a quick reminder that osteopaths don’t just treat backs!

I had an interesting patient in recently who’s been coming along to Mulberry Osteopaths on and off for almost 10 years, so she’s pretty much aware of what osteopaths treat and how effective the treatment can be. We’ve treated her through the stresses and strains of motherhood, sporting injuries, and the effects of spending too long stuck at a desk for work. However, this time she came along with something a bit different from her usual problems.

Although I had treated her over the summer with a netball induced injury she didn’t think to mention at the time that she’d been having problems with tightness in her throat for a number of months. This eventually got to the point where she decided to see her GP who essentially decided that it was ‘just a muscular problem’ and probably ‘stress related’, so the way forward would be to prescribe diazepam.

Diazepam was prescribed quite commonly when I first started off in practice and it was often added to the prescription of pain killers for it’s muscle relaxant effects.  It still gets used now-a-days for low back problems associated with muscle spasm, but only for short periods because of the risk of getting hooked.

This particular patient wasn’t especially keen on the idea of taking diazepam but the mention of a ‘muscular problem’ made her think that maybe osteopathy could help.  Sure enough after a couple of treatments the problem that had been annoying her for about 8 months had more or less cleared. This just proves the fact that osteopathy is better than diazepam . . . at least in this case.  In this instance most of the tightness focused on a couple of muscles called the scalenes which run from the sides of the vertebrae within the neck and extend down to attach to the first couple of ribs. Not the most comfortable of muscle groups to be worked on but given that the treatment worked so well it was worth a bit of short term discomfort.

So I suppose one of the things to remember is to mention anything that is going on with your health when you are in for treatment.  It may well be that some osteopathic input can work even if you don’t necessarily think there’s a link.

Windy Back Pain

What’s the link between low back pain and a grumbly, windy gut? If you suffer from both have you even considered that the two might be linked? It could all be down to a tricky old muscle to treat called the iliopoas muscle.

Here’s the anatomy bit and you’ll have to use your imagination here as we’re talking about a muscle that isn’t visible on the surface because it lies deep within the abdomen. Don’t panic, I’ll keep it simple.  We have an iliopsoas muscle on both sides of the body and it runs from the front of the lumbar spine in the low back, underneath the intestines, then into the pelvis to eventually attach to the groin area.

Mechanically speaking it’s referred to as a hip flexor and if there are problems with this muscle it can lead to low back pain or hip pain.  However, it can also lead to a grumbling gut as a result of the muscle pushing forward into the intestine and generally compressing the passage of the gut. So this is why the achy back can also be accompanied by bloating and abdominal discomfort.

The other thing to bear in mind is that we have to think about this in a wholistic way by considering that whilst the iliopsoas might affect the gut the gut can also affect the iliopsoas.  If you have irritable bowel type symptoms this might in turn irritate the iliopsoas and cause it to spasm leading to an achy back.

Either way, from an osteopathic point of view we need to treat the muscle and the areas it attaches to. Given that it’s path is actually deep in the abdomen and beneath the gut you can appreciate that it’s not necessarily the easiest muscle to get to . . . Especially in those individuals with a touch of extra padding over the gut! However, it can still be worked on by working on the low back, pelvis and the hips.

It’s also good to find a stretch to reach the muscle to back up the osteopathic treatment to stop it from tightening up again.  This is where a nice deep hip flexor stretch is useful, especially in a kneeling lunge position. And you have to be prepared to hold the lunge for a while so as to get past the pull on the more superficial hip flexors like the quadriceps before it gets down to the iliopsoas.

So next time you’ve got a touch of wind along with your sore low back you might get the connection.

Yoga Holidays, airplane seats and squatting

I recently got back from a great yoga holiday in Spain.  Highly recommended and if you’re interested check out their website at www.yogabreaks.org.uk. Nothing too taxing, two sessions of yoga a day, lovely place, nice group of people and plenty of down time. What could be wrong with that? Nothing really, apart from having to cope with the joys of air travel to get there and back. Who exactly did they have in mind when they designed airplane seats? I’m not talking your top of the range business class comfy seats, I mean your standard Easy Jet seats which most of us use.

Where did they find a human that could sit comfortably in one of those seats? From what I can gather you have two choices.  Option one is to sit nice and upright with your low back pressing comfortably into the back of the seat so that the lumbar support fits in to the curve of your low back. Of course that means your head will be left unsupported by the head rest.  So you also have the option of sliding down the seat so that your head and neck get to rest on the head rest . . .but then your low back is left unsupported and your knees are jammed against the seat in front.  The choice is yours;achy low back or stiff neck and maybe bruised knees, or probably a combination of all of them.

In my 23 years of osteopathic practice I’m not sure I’ve come across anyone that would perfectly fit an Easy Jet or Ryan Air seat. I do however see lots and lots of people who’s problems are either associated with or aggravated by sitting on seats of some description. Office seats, whether or not they’re ergonomically fitted, ‘comfy’ sofas, car seats and of course seats on planes, all create business for osteopaths (and not forgetting physiotherapists and chiropractors).

Essentially the human body was not designed to sit on seats, especially for the length of time most of us spend sitting. We are better designed for squatting rather than sitting. Now, here’s a great health promoting challenge for you. Spend a few minutes each day squatting. Feet should be flat on the floor if you can, and if not work towards achieving it. It’s a great position to mobilise the hips, lengthen the low back, stretch the Achilles, and work all those core muscles. It’s great for the bowels too.  Who’s bright idea was it to design a toilet to sit on in the first place? Some things are best done squatting . . but that’s another story.

Give us a call after your next Easy Jet flight and we’ll sort out your back and neck issues and in the meantime happy squatting.

The Cheating Body

Why would anyone make life difficult for themselves if there is an obvious easy option? That’s pretty much the way the body thinks when you ask it to do a particular activity.  If you’ve always done something in a certain way the body learns that activity so the easy option is to simply repeat the movement it’s used to.

Take something straight forward like bending forward to pick something up from the floor.  If you were to perform this task ideally the spine would bend uniformly along its length, the pelvis would tilt with the movement and the hips would flex in to position.  Everything would do its job properly and your hands would reach the floor with no problem. Of course, whilst the movement was happening, all the supportive muscles would be working nicely to stabilise the body as it went in to its forward bend.  Abdominal muscles and pelvic floor muscles engaged and the big muscles along the back doing their bit to support the weight of the body as it rolls down to the floor.  That’s the most energy efficient way to do it.

So how many folk do I see that can actually do that? Probably nobody, even those that have invested years in to perfecting their Pilates or Yoga techniques will not be doing it perfectly.  Admittedly the people I see have generally come to me because the system has broken down in some way so they aren’t going to be moving at their best.  However, even when I get someone back to ‘normal’ I’m still not going to see perfection.

The body is designed to cheat which will mean that it will tend to opt for doing movements in the same way it has always done them.  If you’re the sort of person who has very flexible hips and can simply fold from the hips to put your hands flat on the floor without even bending the back why would you want to do it any other way? You can still do the movement, the hips and the muscles supporting the hips will do all the work and the back can pretty much not get involved. However, do that enough and the hips might start to complain about all the work they’re doing.  That’s the time to rethink your technique and get the spine woken up again . . . . if you can remember how to do that. 

As much as you try to get the whole thing working properly and more efficiently the default setting will be for the body to cheat again and over work the hips.  Breaking habits is hard work. An osteopaths work here is firstly to assess what’s gone wrong so that you know how you’ve been cheating.  Then, with hands on work, we can help you to prepare the body so that there’s a chance that you might be able to work the right areas and engage the correct muscles through work on the soft tissues and mobilisation of the affected joints.  However, that’s when the patient has to do some work by introducing the right exercises to effectively retrain the body to move more efficiently.  Not only the right exercises but also the right technique. That means hard work to get the exercise right because the body will still want to cheat and do it the old way.

However, it’s not all doom and gloom.  The good news is that the body is incredibly good at adapting. If one area isn’t working particularly well something else will work a bit harder to compensate.  Osteopaths are here to lend a helping hand if the compensatory mechanisms fall apart.

Do You Really Need an X-Ray?

Now, this may be a case of stating the obvious, but if you have back pain, neck spasm or a stiffened shoulder joint an X-ray will not solve the problem.  It might provide a bit more information about the problem but, by itself, it will not change anything.  The same is equally true of MRI scans, which will give a fantastic view of all the tissues involved, not just the bones, but again it’s not the cure.

Osteopathy is a very ‘hands on’ therapy.  We like to get our fingers and thumbs into the tissues to have a good poke around the joints and figure out what’s going on. Whilst we certainly get plenty of clues from a patient’s description of the symptoms, it’s our hands which really help us form the diagnosis and give us a picture of what’s happening.

Without an X-ray or a scan we already have a good idea as to what the problem might be, whether it’s a case of osteoarthritis, a worn out disc in the spine or a simple strain injury.  However, we will often get patients thinking that an X-ray or a scan is the way forward in their quest for answers.  More often than not the results of an X-ray or scan will not change the treatment plan. Indeed, because of the health and safety issues related to X-rays and the radiation doses involved doctors don’t request these examinations as often as they used to.

In the days when there were less restriction on X-rays I would often get patients arrive at the clinic with tales of ‘The X-ray says it’s arthritis’. I would have to carefully explain (not wanting to majorly disagree with the GP) that arthritis doesn’t happen overnight, it takes time to develop, so the fact that the pain has only been around for a couple of weeks probably means that it’s not all to do with the arthritic joint. Just because an X-ray shows a bit of arthritic wear and tear doesn’t mean that nothing can be done.  X-ray anyone over the age of 40 and you’ll find some arthritic changes somewhere but it doesn’t have to mean pain or disability.

Also, whilst MRI scans may in themselves be less of a radiation hazard than X-rays they are still often held in reserve unless surgery is a possibility and the surgeon wants a better understanding of what will be found during the surgery.

There are plenty of trials which suggest that MRI scans can almost provide too much information.  Research often concludes that if a completely healthy, symptom free bunch of people were to undergo MRI scans the results would indicate all sorts of ‘problems’. So with scan results we have to watch out for a host of red herrings that have little or nothing to do with the symptoms.

Of course, if there’s been some trauma, you’ve fallen out of a tree, been hit by a car, come off your mountain bike or something similar then A&E may well sensibly get you X-rayed to check for fractures and dislocations. However, if it’s not an obvious crash or collision don’t necessarily be in a rush to get to your GP to demand X-rays and scans.

There is no doubt that X-rays and scans have their place but it’s surprising what a good pair of hands, some sensitive fingers, a pokey couple of thumbs and some common sense can detect.