Avin Patel

Cervicogenic Headaches

Headaches are classified by their cause, and “cervicogenic” just means “originating in the neck“.

Cervicogenic headaches: muscles involved and distribution of pain

Cervicogenic headaches are very different to migraines as they do not come with nausea, aura, or visual disturbance. They also differ from other headaches in that:

  • They are not particularly intense
  • There is no association with medication use
  • Feelings of congestion in the nose or ear, or a running eye or nose are not present

There are a few different ways that this kind of headache can be explained:

Muscular pull

At the very top of your spine there are four small muscles that attach to the skull. They work with larger muscles and some blend into the tissues of the scalp. When they are tight they can pull on the scalp and cause pain right over the top or side of the head. Calming down the muscles will typically give relief.

Referred pain

The muscles and other tissues can have a less direct effect leading to pain. Nerves that supply the back of the neck and scalp areas can misinterpret pain signals. Therefore the brain believes there’s pain in the head rather than just the area of the neck that’s sending out signals.

First Aid for cervicogenic headaches

This kind of headache often doesn’t last long and can often be well managed at home.

Are your neck muscles being tightened by prolonged sitting in one position? Using a laptop on the sofa or in bed often leads to holding your head in such a way that the muscles have to work hard. Changing position or resting briefly may be enough to let the muscles relax.

Putting a warm or cool compress on the back of the head and neck for a few minutes encourages the muscles to ease off.

Osteopathy for cervicogenic headaches

If you frequently suffer from cervicogenic headaches, there may be an underlying cause that needs to be addressed. Because the cause of this pain is the neck, your osteopath might assess your neck, shoulders, and upper back. If you have any problems in these areas such as recent injury or surgery that may make you hold yourself differently, this will be relevant.

Sometimes there is a problem with ligaments, joints, or discs in the neck that causes cervicogenic headaches. Again, your osteopath can seek these causes out and get to the bottom of them.

Stress and anxiety can also cause tightening through the shoulders and neck. Although your osteopath can’t help with stress itself, we can help retrain your breathing. This means making sure that the main respiratory muscles are working efficiently and taking the load off the smaller muscles in the shoulders.

A combination of exercise and osteopathy has been proven to significantly benefit patients who suffer from cervicogenic headaches. These effects are particularly long lasting in those who continue their exercises.

Book an appointment to get to the root cause of your headaches


The sciatic nerve runs from the lower back down the back of the thigh and outside of the calf. Sciatica is a symptom of irritation of this nerve.

Scatica and its causes


When the nerve is irritated, symptoms can develop anywhere along the length of it. For some people this means pain from the back to the foot, and for others it can be a lot more focal. A sharp, shooting pain in a defined line is a typical symptom of sciatica. This is rarely constant but might be somewhat unpredictable. Pins and needles in the same area, or numbness or weakness are also common.

If the cause is a disc bulge, movements that stress the disc can aggravate symptoms. Examples of this are heavy lifting, twisting, and straining on the toilet. It is important to note that symptoms are not indicators of damage. Nor does intensity of symptoms predict how long an episode will last. Sometimes people with the most debilitating pain are the quickest to recover.

Causes of sciatica

The basic cause of sciatica is irritation of the nerve in the back or upper leg. There are a number of ways this can happen, and sometimes there are multiple causes. Two of the most common are:

  • Nerve compression in the back due to a bulging disc (diagram C)
  • Nerve compression in the buttock due to a tight gluteal muscle (piriformis syndrome)

When is Sciatica not Sciatica?

Not all pains in the back of the leg are down to the sciatic nerve.


The sciatic nerve runs through the same area as the hamstrings, so pain can be mistaken for sciatica when it’s not a nerve at all. A simple pulled muscle can imitate the symptoms without any sciatic involvement.

Referred pain

Sometimes the brain misinterprets pain signals and detects pain where it shouldn’t be. You may have heard of people having heart attacks but experiencing jaw pain: this is the same mechanism. Nerves cover a broad area, so when a nerve brings a pain signal to the brain, the brain has to work out where exactly the pain is coming from. Heart pain isn’t a usual sensation, so the brain thinks the pain must be coming from somewhere else in that nerve’s area. One nerve that supplies the heart also supplies the jaw, so the brain makes an educated guess.

The same can happen in the back and leg. Irritated joints in the lower back and pelvis can cause pain in the back of the thigh. This doesn’t necessarily mean that anything is wrong with your leg! Your osteopath can work out what’s happening and what needs to be done.

Plantar fasciitis

Pain and pins and needles in the foot can be symptoms of sciatica, but when they’re isolated to the sole of the foot alone they could be something else. Plantar fasciitis is inflammation of the soft tissues on the sole, unrelated to the sciatic nerve.

Book an appointment today to get on top of your sciatica

Sports Injuries

Minor sports injuries are frustrating, especially when they limit your return to exercise. Osteopaths can help you from the early stages of injury to rehabilitation to help you come back more resilient.

Ligament sprains

Sprains are a very common injury from all kinds of sports. A sprain is an injury to a ligament, whereas a strain is a muscle injury. The former is graded from 1 to 3, with 1 being very minor and 3 being a total rupture of a ligament.

All grades can be accompanied by swelling, tenderness, heat, and redness. Second and third grade sprains show excess movement on examination, ranging from laxity to instability.

Ankle sprains are some of the most common sprains. The three main types types are inversion, eversion, and high ankle sprains. These are all caused by different movements as illustrated below:

The first aid advice for sprains and strains has changed: no longer do you “RICE” a soft tissue injury, you now give it “PEACE and LOVE“! Although the “PEACE” part of the plan is similar to the rest, ice, compress, and elevate of “RICE”, there’s now focus on rehabilitation too.

“LOVE” stands for: Load, Optimism, Vascularisation, Exercise. After an injury like this, it can be hard to work out the best way to return to normal on your own. These new guidelines show the importance of getting the rehab right, and this is somewhere your osteopath can help. Combining work done in the treatment room with exercises to safely re-strengthen the whole area helps with all four elements of “LOVE”.

Sports injuries to cartilage

Cartilage in the shoulder and knee can be susceptible to injury in throwing and twisting sports.

Shoulder cartilage: the labrum

The shoulder is a very mobile ball and socket joint because the socket is so shallow. There is a larger part of cartilage that sits within the socket and extends around the ball of the shoulder slightly called the labrum. In sports that involve a lot of high power, large range shoulder movement, the labrum can be injured. Read more about labrum injuries on our dedicated post here.

Knee cartilage: the menisci

By a similar mechanism, the menisci of the knee can be injured by twisting through the knee while weight-bearing. This is one sports injury you’ve probably seen in footballers. Each knee has two menisci that both sit on the top of the shin bone: the medial meniscus and the lateral meniscus. These are both roughly C-shaped pieces of cartilage which cushion the joint and distribute weight across the surface of the knee bones.

With both the labrum and the meniscus, injuries can cause immediate pain and delayed swelling. Cartilage has a poor blood supply, so the swelling is initially the body’s way of getting nutrients to the area; but we want to keep this fluid moving to remove the waste products from the joint and bring in more nutrition. Osteopathy can help here.

By keeping the area around the injury at its best condition, your osteopath can help keep that fluid moving. This gives the injury the best environment possible to heal itself. As the injury improves, you may be given more exercises and advice to restrengthen the area and get you back to normal.

Your osteopath will also be monitoring your injury to check the progress is in line with where it should be, and can refer you on for imaging or further intervention as necessary.

Overuse sports injuries

Sports injuries: tennis and golfers elbow

Repetitive movements such as those needed for racket sports can sometimes cause inflammation around the muscles in question. One obvious example is epicondylitis:

  • Lateral epicondylitis is tennis elbow and affects the extensor muscles.
  • Medial epicondylitis is golfer’s elbow: the wrist flexor muscles are involved

In both cases, the end of the muscles around the elbow become inflamed.

Your osteopath can easily diagnose epicondylitis and work to ease off the irritated muscles and reduce surrounding inflammation. As with most things, the sooner your injury is addressed, the quicker it can be resolved.

Alongside exercise advice, your osteopath may suggest changes to make with regards to your sporting equipment. For example, a thicker grip on a handle is easier on the forearm muscles than a thinner one.

Avin has a background in sports as an ex-professional rugby player. Book an appointment for your sports injury today.

Lower Back Pain

Roughly 80% of us experience low back pain at least once in our lives, but the vast majority of cases are not serious. Even cases that lead to time off work are not necessarily indicative that something is damaged.

Osteopaths can help with lower back pain formally categorised as “non-specific”. This is an umbrella term that includes pain caused by:

  • Tight or strained muscles
  • “Slipped” discs
  • Irritated joints in the spine or pelvis
  • Ligament sprains in the back

“Non-specific” does not mean that we don’t know what is causing your pain or that we can’t do anything about it. It just means that more serious causes such as fractures or disease can be ruled out.

Do I need a scan?

These non-serious causes rarely correspond to findings on MRI or X-Ray. Making an appointment with your osteopath before getting a scan could mean being symptom free before your hospital appointment date.

In fact, evidence shows that MRIs show problems with discs in people without symptoms, so scans are far from the gold standard for diagnosing back pain. This is one reason that imaging is no longer recommended as a GP’s first strategy for straight-forward back pain. You also don’t need a doctor’s referral to see an osteopath, you can make an appointment yourself.

Due to comprehensive training, osteopaths are able to distinguish between non-specific lower back pain and more serious causes. If your back pain does require medical attention, we can support you in getting to the right practitioner.

How can I prevent lower back pain?

Some lifestyle factors have been shown to predispose an individual to developing lower back pain. These include:

  • Being overweight
  • Lack of activity
  • Overexerting during physical activity, including at work

So staying active without pushing too hard, and staying at a healthy weight will help to prevent future episodes.

Problems with the lower back are often linked to dysfunction elsewhere, such as stiffness in the upper back. Upper back restriction is something we commonly see in clinic, often exacerbated by long periods of sitting still such as when stuck at a desk. When the upper back is restricted, the body compensates by putting more movement through the other areas of the back. This can cause the muscle tension and strains mentioned above.

During an appointment, your osteopath will look at the whole body. This means we can identify these areas of restriction before they cause symptoms. Exercises and advice to keep these stiff areas at bay are also great ways to prevent episodes of pain.

What can an Osteopath do for back pain?

Osteopaths use a range of techniques for pain relief and rehabilitation. Hands-on techniques such as massaging and stretching muscles, or moving and clicking joints can be useful. Avin is also qualified in Medical Acupuncture, which has been proven to improve low back pain.

Because osteopaths look at the whole individual, we are in a position to find any factors that might have fed into the symptoms you have today.

Back pain can be debilitating and scary, so an important part of your treatment plan is rehabilitation. Exercises help keep your back happy between treatments, but they also serve the purpose of letting your body know that it is safe to move. The sooner we can get you comfortable again, the sooner you can get back to normal.

If you suffer from these symptoms, you can make an appointment at any of our 6 clinics.