Avin Patel

Frozen Shoulder

The technical name for frozen shoulder is “adhesive capsulitis”, which gives a good idea of what’s happening in the joint. Surrounding the ball and socket joint of the shoulder, there is a capsule of soft tissue. It’s a flexible material that allows the shoulder to move properly and keeps the joint fluid inside.

But in frozen shoulder it becomes sticky (or “adhesive”). This causes restricted movement and pain, particularly in the movements illustrated below.

Frozen shoulder: affected movements and anatomy

Factors involved in developing Frozen Shoulder

Often it is unclear why this develops. Sometimes it may follow trauma, including surgery, but other times it has no identifiable trigger. We do know that some other conditions are associated with a higher risk of adhesive capsulitis, such as:

  • Diabetes
  • Parkinson’s disease
  • Heart disease

There’s also a link to immobilised shoulders. This is one reason you don’t want to wear a sling unnecessarily for mild shoulder or elbow injuries. It is unclear how this predisposes a shoulder to freeze, all we know is that it happens.

Finally, as one shoulder “thaws”, there is a relatively high incidence of the other one freezing. Again, the reason why is unclear.

Prognosis for Frozen Shoulder

Unfortunately, this is not a quickly resolving condition. The good news is that it appears to be self-limiting, and responsive to conservative treatment. It can be broken down into three stages, each with their own timeframe.

Freezing

The first stage is called the freezing stage. This covers from the first changes to the point of most restricted movement.

The freezing stage can last up to nine months. This early stage appears to be most responsive to acupuncture.

Frozen

This period is the most restricted in terms of movement, but not necessarily the most painful. Pain from the freezing stage begins to resolve, or at least doesn’t get any worse.

The frozen stage has a very variable timeframe, lasting somewhere between 4 and 20 months. This period may be reduced by manual therapy.

Thawing

The tail end of the resolving stage can be long and drawn out. But as both pain and movement are improving, it might not feel so long.

Similar to the frozen stage, thawing can last from 5 to 26 months.

Management

Encouraging movement from the joint and surrounding muscles in the treatment room can benefit the shoulder. Limiting maximum lost movement and speeding up the three stages is the aim in treatment.

Medication is the second line of treatment. Anti inflammatories, including both NSAIDs and steroids can be prescribed for frozen shoulder. Sometimes a steroid injection will also be offered, although there are long term side effects of steroid injections, and no real long term benefits for this condition. Surgery is another option, but it is not routinely offered.

In summary, adhesive capsulitis is a frustrating condition to have, but there are ways your osteopath can help at all stages. As early stages seem most responsive to acupuncture, it’s worth getting checked out as soon as you can.

If you suspect you have frozen shoulder, get on top of it sooner rather than later. Book in today.

Neuralgia

Neuralgia literally just means “nerve pain”, but it is used to mean something more specific.

Examples of neuralgia

The basics

Technically any pain, like a mild trapped nerve, could be called neuralgia. But the term is actually used to describe significant sensitivity, not just irritation.

It is often associated with other conditions, such as diabetes or multiple sclerosis. It can also be post-viral, as with postherpetic neuralgia. In all of these cases, a nerve is irritated or damaged, which leads to its sensitisation.

Symptoms

Sensitisation makes painful sensations more painful, and some non-painful sensations surprisingly uncomfortable. This could mean that the feeling of bedsheets on skin is unbearable, for example.

Pain in neuralgia can be described as burning, electric, sharp, or stabbing. In contrast, it can also feel like more of an ache. Typically this pain will follow quite a defined line, which is a clear sign to your osteopath that the pain is following a specific nerve.

Trigeminal Neuralgia

One of the nerves that supplies the face is the trigeminal nerve. It branches into three smaller nerves:

  • Occipital (upper) branch: supplying the top of the face
  • Maxillary (middle) branch: supplying the middle of the face
  • Mandibular (lower) branch: supplying the bottom jaw

Usually it is the middle or lower branch that is affected, and very rarely does it affect both sides. Pain can come out of nowhere, or follow exposure to cold air, touch, or eating. Pain is severe but usually quick to pass. However it might come and go throughout the day.

In addition to the possible causes mentioned above, trigeminal neuralgia can be caused by pressure from a blood vessel. Your GP may want to send you for a scan or further to make sure nothing serious is causing the irritation.

Evidence suggests that osteopathy can be beneficial for pain relief in trigeminal neuralgia. Although it is unlikely that we would be able to affect the root cause of the pain, we may be able to help to calm the nerve down. Your GP may offer painkillers and suggest you keep a pain diary to better understand your triggers.

Postherpetic Neuralgia

Shingles is caused by the same virus as chicken pox: herpes zoster. It can become symptomatic years after recovering from chicken pox because it stays dormant in the nervous system. The rash from shingles tends to follow the course of a nerve, so it’s not too surprising that there might be neurological symptoms.

After the rash fades, you may find symptoms of neuralgia in its place. These can include the sharp pains and increased sensitivity mentioned above. Symptoms typically self resolve within a year, but the process may be sped up with treatment. Osteopaths work with nerve pain frequently, and can use techniques to try and desensitise the nerve.

Shingles is highly contagious, and you should not see your osteopath before the rash has cleared. You can get in contact to discuss your symptoms if you’re not sure whether you’re safe to come in yet.

If you suffer from neuralgia, make an appointment and see what we can do for you.

Hip & Knee Arthritis

Arthritis often affects the hip and knee joints.

The basic progression of osteoarthritis

Osteoarthritis is the wear, tear, and repair process on cartilage.

  1. Mild injury or discomfort causes subtle changes to the movement in a joint
  2. This develops into an avoidance of a certain part of the joint
  3. The cartilage there is no longer being compressed and decompressed as normal. This means nutrients are not being squeezed into the tissue and waste products are not being squeezed out. The health of this cartilage declines
  4. To avoid the pain of moving over rough cartilage, the body further limits movement.

So although the body tries to protect itself, it actually allows the arthritis to develop further. This is not a prognosis that needs to continue: your osteopath can help.

Arthritis in the hips and hands

Knee arthritis

The knee is actually made of three joints:

  1. The main hinge joint
  2. The joint between the knee cap and the hinge joint (patellofemoral joint)
  3. The two shin bones: tibia and fibula (superior tibia-fibula joint

Any of the three can develop arthritis. It can be particularly easy to spot when it affects the joint behind the knee cap.

Knees are normally quite crunchy joints, but this is more obvious in an arthritic knee. A healthy crunchy knee might make noise but it won’t catch or feel stiff on movement.

To try and protect the knee, the body might tighten the quadriceps muscles. Again, that isn’t really helpful. The quadriceps attach to the knee cap, so when they get tight they pull on the joint they want to protect. This can cause more pain and change the way a person moves. The cycle of restriction and poor joint health continues.

Fortunately, this joint is really responsive to osteopathic treatment. If you have arthritic knees, you might be able to see progress from the first appointment.

Mechanical compensation for hip arthritis

Postural changes due to hip osteoarthritis

When osteoarthritis develops in the hip, it can lead to a total change in posture. Typically it affects the back of the joint first, and the body might react to this before you’re conscious of any problem. In order to prevent pain, the body avoids taking the hip back as far as it can. This means strides should be shorter when walking, for example, because the leg doesn’t go back as far as it used to.

But the body is clever and it finds a way around this problem. The solution is The Elderly Posture.

If you bend slightly forward at the hip, you can take steps the same length as normal but without that painful extension. You go further into flexion than you normally would, but don’t have to go past neutral when it comes to extension! To avoid falling over, the body has to compensate higher up. This could mean leaning back through the spine, or sometimes just lifting the head through the neck.

But of course there are side effects to this, apart from suddenly moving like you’re 20 years older. Failure to move through the arthritic part of the joint means failure to bring nutrition to where it is needed most. The joint continues to develop arthritis until movement does become painful. Load is also redistributed through the areas that are compensating. Holding your head up all day is hard work, and the neck is not designed for it.

If you’re already at this point, osteopathy can help, but prevention is better than cure. Catch the arthritis early and you’ll be in a much better position, literally and figuratively! Contrary to popular belief, osteoarthritis can be managed before the need for a joint replacement.

Address your arthritis as soon as you spot it. Book an appointment today.

Fibromyalgia

Fibromyalgia is a poorly understood condition characterised by widespread pain and sensitivity. It is considered to be a neurological condition in which the central nervous system starts processing sensation incorrectly.

Symptoms of fibromyalgia

Symptoms of Fibromyalgia

  • The main symptom of fibromyalgia is pain. Typically the pain is widespread and does not follow any particular patterns.
  • Stiffness, especially in the morning or after periods of sitting still
  • Unusually high sensitivity to pain
  • Poor sleep, fatigue
  • Cognitive difficulties, known as “fibro fog”

We know that onset often comes between the ages of 30 and 50, particularly after a stressful period of time. There is also a genetic link with siblings of patients being more likely to develop fibromyalgia themselves.

Understanding as much as possible about your condition will help to control its symptoms. Some patients find that being given a formal diagnosis is relieving, and learning about the science of pain gives them more control. There are good resources online that can help.

Your Osteopath’s job

One of the best ways to manage the symptoms of fibromyalgia is with an exercise plan. This can be designed alongside osteopathic treatment, and we can monitor your progress as part of your treatment plan. Some people also find acupuncture to be helpful. If appropriate, we can trial this with you.

If your fibromyalgia causes stiffness and tension into the neck, it may cause cervicogenic headaches. We can help to manage the symptoms of these headaches.

Fibromyalgia can present similarly, or in conjunction to other conditions, such as rheumatoid arthritis or trapped nerves. As part of your assessments, we will look at the behaviour of muscles, joints, and nerves. If a nerve is trapped, it follows a specific pattern of symptoms. This means we can differentiate between fibromyalgia pain and nerve pain. We can also highlight symptoms of other conditions that might need further investigation.

Referring on

Diagnosis is still controversial, as some professionals regard fibromyalgia as a collection of symptoms rather than a condition. Current thinking is that it is a disorder that falls on a spectrum, and a questionnaire is a useful tool for diagnosis. It would be useful for your GP to complete this with you, but your osteopath can do so too.

One treatment with that can be effective is CBT: cognitive behavioural therapy. You may be able to organise this through your GP, or you may prefer to find a therapist yourself. Support groups can also be really helpful.

Medications can also be useful. There are a number of different families of painkillers that can be effective for managing pain like this. However there is a lot of variation in how different people react to different drugs. It is not unusual for your GP to work with you through a number of medications before finding one that suits you.

Book in to see how we can help with your chronic pain.