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.

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!