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.

A Little Imbalance is Good For You

As an osteopath I don’t expect to see perfection.  I don’t see perfectly straight backs.

As far as I’m concerned the perfectly straight back simply doesn’t exist, despite the fact that some professions with an interest in physical therapy seem to almost scare patients half to death with the warning that their spine isn’t straight, that there’s a scoliosis (a posh term for a twist in the spine).

Let’s look at this sensibly.  Most of us are right handed or left handed. Even in folk that are apparently ambidextrous there will still be a dominant side.  This natural imbalance in the way we use our bodies inevitably results in different development on either side of the body.

If you are right handed the chances are that your right shoulder, arm, wrist and hand is stronger than the other side.  To be stronger there will be better muscle development. It also means that the right shoulder is probably naturally held a little further forward and a little lower than the left shoulder. The flexibility will also be different.  The dominant right arm generally moves more so the right shoulder girdle will tend to be more flexible, whereas the slightly weaker left side doesn’t get as much exercise and is probably stiffer through the shoulder.

This natural imbalance will also occur through the low back, pelvis, hips and legs. Footballers, karate experts, and dancers will all have a preferred leg, a stronger leg or a more flexible leg. So no great surprise that there will always be one leg slightly longer or shorter than the other! 

Imbalance is normal, so long as it’s a little imbalance.  All ‘normal’ folk out there will be walking around with imbalance and they won’t be suffering because of it. Obviously if the imbalance becomes more than a little imbalance then things can go wrong; muscles will complain, joints will stiffen up, aches and pains will kick in.  This is where osteopathic treatment can help to get you back to your normal imbalanced self where you can function happily and comfortably again . . . even if it’s not perfectly balanced.

So if a therapists starts making tut tutting sounds as he mentions a difference in leg lengths, if there are disapproving noises when he describes the twisted pelvis, and if there is a sharp intake of breath when there is talk of a curve in the spine . . . . DON’T PANIC.  Remember that imbalance is normal and expecting to achieve perfection is an unrealistic goal.

Of course that’s not to say you shouldn’t strive to achieve perfection. The closer you get to a balanced structure the better your body will perform, but for mere mortals living a normal life a little imbalance is no bad thing.

I’m happy to admit that as an osteopath I strive to get patients back to a lesser degree of imbalance, to the level of imbalance that’s normal for them. I’m just a therapist, I’m not a magician.

Osteopathy and Eczema?

How on earth can osteopathy be used to treat eczema?  My youngest daughter is now 8 months old.  Born at home, breast feeding went well and continues, weaning is going great and she’s been generally very healthy but there has been an issue with her skin.  She has eczema and all in all it’s getting better with sensible skin care approaches and some homeopathic input.  However, she’s now at a stage where if she gets stressed the first thing she does, even before starting to cry, is to scratch.  So the obvious thing to do is to bring her along to see Lisa for some osteopathic treatment isn’t it?

Osteopathy and eczema shouldn’t be such a bizarre combination if you follow the basic wholistic treatment idea.  The word ‘wholistic’ get’s used a lot nowadays to describe treatments but the fundamentals of what exactly it means to be wholistic often gets lost in translation.  When it comes to treating people we have to remember that they’re complicated things so an osteopath might stick his or her fingers into a sore bit of someone’s back but that sore bit is connected to many other things.  And it’s not just physically connected, there’s also a mind and emotions and belief systems that are connected to that physical pain.  It’s the whole idea of saying that a patient isn’t just a physical body. Don’t forget the mind and the spirit. . . . Very hippy / New Age idea maybe, but common sense none the less.

Everyone will know that when they’re stressed it has a physical impact on the body.  The shoulders might tense up, the breathing might get shallow, tension headaches might kick in so stress isn’t just a psychological thing.  Physical treatment such as osteopathy has a direct effect on the stress response, so if stress is what triggers the eczema then effectively calming down the stress response will ease the eczema.

With an 8 month old baby obviously the osteopathic treatment techniques used need to be adapted and this is where the more subtle so called cranial techniques come in useful. Lisa has had extensive postgraduate training in cranial osteopathic techniques and paediatrics so she’s the lady to see.  Let’s hope it calms down the scratching.

Of course it’s not only babies that can get stressed so even us adults could do with a little bit of de-stressing from time to time.  Given that it’s holiday time it could even be argued that some folk have to cope with more stress during their holidays than at other times!  School holidays, budget airlines, time with family, shattered expectations . . . sometimes it’s a dangerous mix.

So if it does become all a bit too much over the summer some osteopathic input might be just the thing to calm the system down.  Of course we’re also around to pick up the pieces after the luggage induced injuries, the over enthusiastic activity holidays and the plain old seized up car journey backs.

Give me space

Oh no, not another slipped disc!

Let’s get this right, discs don’t slip. If there is one way to make an osteopath hold his head in his hands and moan a little it’s to say ‘I’ve got a slipped disc’. The discs in the spine we are talking about here are well and truly glued and welded to the vertebrae in-between which they sit. There is no way one of them can slip. Are we clear on that now?

So if it doesn’t slip what does it do? Like the rest of the body, if a disc is not treated particularly well it wears out. The nice strong ligamentous shell that encases the slightly more fluid gel like centre can dehydrate, crack and warp.  Eventually a bulge can appear on the disc as it fails under the pressure and, on a really bad day the disc may even herniate or burst allowing the central gel core to leak out.

If a disc herniates you’ll know about it. The leaking gel will press on to the nerve arising from the spine at that level and that pressure will be made even worse as a result of the inflammatory reaction that occurs around the disc.  Inflammation means swelling and swelling in a confined space right next to a nerve is not good news. Pressure on the nerve produces intense pain that normal pain killers won’t touch along with pins and needles, numbness and weakness along the path of the nerve.  This most commonly occurs in the bottom of the back and affects the leg on one side but it can also happen in the neck and affect an arm.

If it gets to the herniated disc stage often surgery is the only way forward.  Better to catch the problem at the slightly warn out bulging disc stage so you don’t have to go down that route.  Bulging discs are not uncommon. Many folk with have them and not know that they are there but eventually, a bit of extra stain or pressure on the spine will push things over the edge. There might be localised pain around the area and protective muscle spasm. The muscle spasm itself can be really very painful.  There may also be signs of the nerve pinching if the bulge is big enough to press on a nerve root, so the pins and needles and numbness may occur. This is your body sending you a warning. Treat this the right way and it won’t necessarily deteriorate into the full grown disc herniation.

The way forward is to create space. The disc has essentially collapsed, usually to one side.  It acts like a deformed balloon, as the bulge appears the structure collapses to the side of the bulge so compressing everything on that side, nerves included. The natural tendency for the body is often to lean to the opposite side in an attempt to take pressure off the bulging side. The muscles all around the area want to hold on tight in an attempt to protect the area so spasm sets in. The problem with spasm is that it compresses things together, which is the opposite of what you really need.  We’re looking for space, to decompress the disc and give it room to reduce the pressure on the nerves.

Creating space by stretching and reducing the muscle spasm is the way forward.  And no, we won’t be following that up by ‘putting the disc back in place’.  If it never came out in the first place it won’t need putting back in!

Breast Feeding and Osteopathy

There must have been a baby boom over Christmas because already we’re seeing more than normal numbers of post natal patients (mums and dads!) to start the year.  Interestingly it’s not just the usual pelvic and low back aches and pains which have been presenting to us. There have also been a number of breast feeding related issues.

If you were to do a Google search for ‘Breast Feeding and Osteopathy’ it’s interesting to see that the majority of the articles that come up are related to potential problems with the baby and how cranial osteopathy can be of use.  Whilst that maybe true I find it strange that more emphasis isn’t placed on the mother. The regular feeding routine, especially through the night time hours can leave its mark on mums’ body. Feeding a little one when you’re half asleep in the early hours of the morning can see you slumped and twisted in all sorts of awkward positions, resulting in a stiff and achy back.  The tensions introduced by poor feeding posture along with the constant strains on the system from nursing a baby can lead to a slowing down of milk flow.

Stiffness across the upper back and shoulders along with a slumped posture with rounded shoulders effectively can restrict the flow of milk to the breast(s).  It can also reduce lymphatic drainage away from the breast resulting in an increased risk of mastitis. You may find that one breast seems to be favoured by the baby possibly because the flow of milk seems better on one side.  This can mean that mum ends up holding the baby on one side more than the other which increases the physical imbalance on the body which further complicates the problem.  Osteopathy can work really well with these sorts of problems.

Of course it might also be useful to get the baby checked over to see how he or she is coping with breast feeding.  This is where cranial techniques can be very effective. It maybe that the birthing process has left baby with a preference for turning the head in one direction and struggling to turn the opposite way. This obviously has potential implications for breast feeding so sometimes both mum and baby need some attention.

Watch out for Winter Hibernation

The clocks have changed and we’re running out of daylight very quickly now.  It’s tempting to head towards a state of hibernation but that potentially means stiffening up and leaving yourself open to injury.  Hopefully Mulberry Osteopaths have helped to get you back on track and we hope that you have managed to keep the old aches and pains at bay successfully over the spring and summer. However, don’t let it all go pear shaped with the change of the seasons!

Top of the list of advice is to stay active which can sometimes be harder to achieve with the shorter days. The long hill walks and leisurely games of golf maybe a bit trickier to fit in so indoor activities may need to take over.  Perhaps it’s time to think about a yoga or Pilates class. It might even be worth looking at winter time gym memberships.

The swimming pool could be another good idea to keep you moving through the winter. There’s also the added benefit of having access to saunas and steam rooms to help you defrost the body on some of the colder days ahead.

Also remember to keep warm when you’re outside. A cold muscle is going to be easier to injure than a nice warm pliable muscle.  School kids might think it looks great to walk around in the freezing cold without a coat but hopefully you’re more sensible than that.  Get the layers on and make sure the hat, scarf and gloves are on hand.

Simply getting outside during the limited daylight hours is in itself useful.  We take the sunlight for granted during the long days of summer but the impact of daylight on the mood should not be underestimated.  In extreme cases folk suffer badly with SAD (Seasonal Affected Disorder) becoming depressed, fatigued and apathetic in the absence of daylight. This has the knock on effect of making the sufferer less active, potentially more sensitive to pain and ultimately more prone to injury or recurrence of an old injury.  If it’s a bright crisp autumn or winters day try to make sure you go for a walk or potter around in the garden.

It’s the time of year to take it easy with your activity and treat your body with some respect.  Remember that you are potentially a bit stiffer than you might like and the muscles are probably a bit tighter than usual so don’t go mad in the garden without a gentle warm up stretch.  Also watch out for the crazy snow clearing activity should that be required. Great for a good cardiovascular workout but your back may not like it so much.

Try not to be the one ringing for an emergency appointment with us over the next few months.  

The Problem and the Pain

Funnily enough the problem isn’t always where the pain is!

Osteopaths are used to seeing people in pain.  After all that’s usually why folk come to see us in the first place. They are hoping that we can relieve or ideally remove the pain.

As far as I’m concerned, one of my jobs as an osteopath is to make sure patients have a better understanding of why they are in pain.  It comes as a surprise to many people when they find out that the bit that hurts is often not really the site of the underlying problem.

We are talking basic mechanics here.  If one area stops working something else normally has to work harder to compensate.  The classic example of this which I seem to be seeing a lot of recently is pain and tension around the hip and buttock.  Okay so we know where the pain is but when we look to see how things are working we find that in actual fact the hip is moving really well and it’s often the base of the back which is stiff and ridged even though there’s no back pain.

The pain around the hip is related to the tension in the muscles and soft tissues that are being worked so hard as a result of the low back essentially not pulling its weight.  Treatment therefore is relatively straight forward. We soften up all the over worked muscles but, more importantly, make sure we back that up with waking up the low back so that it starts moving again.  Working the muscles around the hip alone may provide some temporary relief but patients often find that the problem recurs because the underlying problem has not been addresses.

So the moral of the story is that the problem isn’t always where the pain is.  Step back and take a look at the whole thing.