Avin Patel

Rheumatic Pain

The word “rheumatic” has quite a broad meaning, primarily encompassing problems with joints.

What’s the difference between osteoarthritis and rheumatoid arthritis? Whereas we think of osteoarthritis as a more mechanical process of wear, tear, and repair, rheumatoid arthritis is led by inflammation. One hallmark of inflammatory arthritis is that it is worse after rest- waking up with pain that takes more than half an hour to ease can be an indicator of this.

Some other conditions in the same family include:

  • Rheumatoid arthritis (RA)
  • Psoriatic arthritis
  • Ankylosing spondylitis or AxSpA

Early stage rheumatic diseases are easily missed because they act like a number of other conditions. However there are often subtle differences in the early stages that your osteopath will be aware of. If something doesn’t seem quite right, we may refer you to your GP for blood tests and other investigations.

Effects of Rheumatic Diseases

Examples of Rheumatic Diseases

Osteopathy will not cure rheumatic diseases, but it can help to manage the symptoms.

Rheumatoid Arthritis (RA)

One of the better known conditions is RA. Like most of them, it is an autoimmune condition where the body attacks its own joints. There are a few varieties of RA, with some coming with periods of remission.

RA can affect the hands, causing increased bony growth over finger joints and leading the hand to point away from the thumb (ulnar deviation). These are the effects of damage caused by RA and the body’s attempt to correct it.

The joints of the spine can also be affected, and this may be one of the first symptoms to show. Your osteopath will be looking out for indicators of RA.

Psoriatic Arthritis

Roughly a third of people with psoriasis will also have psoriatic arthritis. This behaves similarly to RA in that it also attacks the joints and can come and go. Psoriatic arthritis often affects the small joints of the hands and feet, and can come with changes to the fingernails.

PA can also attack the spine. As PA symptoms can start before psoriasis itself does, it can easily be mistaken for another kind of back pain. Your osteopath will look for inflammatory signs and symptoms to find the true cause.

Ankylosing Spondylitis (AS) /AxSpA

AS is poorly recognised but there is progress being made. Its name refers to how it causes fusion of the spine and pelvis (ankylosis). Early symptoms can be quite diffuse, so it can be missed before the late stage when it causes ankylosis. The term to encompass it at all stages is Axial Spondyloarthropathy (AxSpA)

Your osteopath is in a great position to help you get a diagnosis. This can only be made by a rheumatologist but there are tools your osteopath can use to support a hypothesis and help get you referred.

Treatment for AxSpA should be gentle and little but often. You can turn around a painful day with five minutes of treatment, but overtreating can make it worse.

A diagnosis of AxSpA opens the door to strong medications that can slow the disease process.

How can osteopathy help with rheumatic pain?

We can’t cure inflammatory diseases but we may be able to help with symptom relief and getting a diagnosis.

Osteopathy can help provide symptomatic relief to the affected joints and help keep the rest of the body working well to accommodate this.

If you need help for your rheumatic pain, book an appointment today.

Shoulder or Elbow Pain

The shoulder is more than just a ball and socket joint. It is a very mobile joint supported by a number of ligaments and strong muscles. There are other smaller joints that make up the shoulder complex along with the ball and socket, and all have their own functions and susceptibilities.

The elbow is mainly a hinge joint, but there are additional joints to incorporate the two forearm muscles. The elbow is much less mobile than the shoulder, which may be why we see a lot fewer elbow injuries in clinic. But there are still things that can go wrong, and ways in which your osteopath can help.

Shoulder Pain

Sports injuries can cause a number of shoulder problems. These can be immediate or further down the line after insufficient rehabilitation. Read about sports injuries such as labrum tears here.

Frozen Shoulder anatomy and movement

This is a non-exhaustive collection of conditions your osteopath is qualified to help you with:

Shoulder Arthritis

Osteoarthritis can affect the ball and socket joint. As this joint is similar to the hip in its structure, arthritis affects it in a similar way.

As with anywhere else, there is always something that can be done to make an arthritic shoulder more comfortable. Working to release the muscles that are guarding the joint is one step in the direction of improving movement. If the movement can be improved, the cartilage can begin to heal, or at least slow the progress of the arthritis.

Your osteopath will also look at any adaptations your body has made to compensate for lost movement. This improves joint and muscle health globally- not just at the affected joint.

Biceps Tendinopathy

Tendinopathy is a term that encompasses tendinitis/tendonitis and tendinosis. It refers to inflammation of the tendon- in this case the tendon of biceps brachii.

Usually the long head of biceps is affected, but not the short head. The long head attaches onto the shoulder blade before running very closely to the ball and socket joint. It may be because of this close proximity that it is susceptible to irritation, especially by repeated overuse such as overhead throwing.

Other conditions also predispose the development of biceps tendinopathy. Otherwise asymptomatic changes, such as those to ligaments around the scapula, can make this injury more likely. Or more obvious things, like rotator cuff injuries, can put added strain onto the biceps. There is also a link with shoulder instability, such as after a dislocation. It is important to get injuries like this checked out, even if they seem minor.

Rotator Cuff Injury

Following on from biceps, another commonly treated shoulder injury is of the rotator cuff. This is a collection of muscles around the shoulder blade that work together to rotate the arm.

A fall or other trauma, including sports injuries, can strain the rotator cuff. Conservative management is the recommended first line of treatment. When the injury is mild enough, you can avoid surgery and the shoulder can be rehabilitated by your osteopath.

Preventing your shoulder injury is better than curing it!

You may notice that a lot of shoulder injuries are associated with overhead throwing. If you do a sport that requires this movement, or work in a role that leads to a lot of overhead work, preventative treatment may be a good strategy for you to avoid an injury. Book in here.

Elbow Pain

We see much fewer elbow problems than shoulder problems in clinic, but that’s not to say we can’t still help. One of the most common elbow complains is epicondylitis: tennis elbow and golfers elbow. This condition is easy to identify and there is plenty that can be done in the treatment room and at home to speed up its recovery. To read more about epicondylitis, see our full post on the topic.

Sprained Elbow

The elbow is a hinge joint, and it is supported by a lot of ligaments. Injuries that force the elbow to straighten too far, or bend slightly sideways, can cause a sprain. This usually affects the big ligament on the inside of the elbow.

Shoulder and elbow anatomy

One common mechanism of injury is a fall onto an outstretched hand which can cause the elbow to buckle back. This movement is limited by ligaments as well as bone. In high power injuries it is important to check that there is no fracture.

If your injury is confirmed to be a purely soft tissue injury (or if the fracture is healing well), your osteopath can step in. Ligaments have a poor blood supply, so need to be surrounded by healthy fluid to heal quickly. This means that some swelling is actually helpful- but it is important not to let that fluid stagnate. Your osteopath can help with flushing the old fluid back towards the heart. They can also give you exercises to encourage the same movement at home.

Ligament injuries can be slow to heal, but it is important not to over-protect the injury. Immobilising an elbow sprain unnecessarily can make you more likely to develop frozen shoulder. As the ligament heals, your osteopath will encourage you to start moving it as much as is appropriate. This helps the fibres knit back together in the correct direction, making a stronger ligament than a poorly rehabilitated one.

Elbow Bursitis

Bursae are fat pads found all over the body, sitting between bones and soft tissue as a cushion. Their role is to prevent friction. The one sitting on the tip of the elbow is the olecranon bursitis, and it can form an egg-sized lump when irritated by prolonged repeated pressure. One cause of this could be sitting at a desk with a bent elbow resting heavily on the table. This is why we also call it “student elbow”.

Beyond advising you to stop applying pressure to the elbow like this, your osteopath can help by looking further afield. There may be a relationship with the triceps muscle or other local structures that can be addressed. There may even be a tightness in the back that encourages leaning to that side. Your osteopath will look at the body as a whole to get to the root cause.

If you have a problem with your shoulder or elbow, make your appointment to get it sorted here.

Cramps and Muscle Spasms

It’s a common misconception that cramps are caused by dehydration or electrolyte imbalance. Even for sport-related cramps, there is little to no evidence of this.


Causes of cramps

There is a lot we don’t know about cramps. The general understanding is that cramps affect voluntary muscle, but the cramp itself is involuntary. This is likely down to excessive excitability in a nearby nerve. Part of the muscle in question goes into spasm, so there must be a neurological driver. Beyond that, knowledge is scarce.

Who do cramps affect?

It’s not unusual to experience the ocassional cramp, but some groups of people experience them more than average.


The theory to explain why cramping is more common after exercise is about fatigue of nerves. After running, the nerves in the leg are fatigued in a similar way to the muscles. As they recover, they misfire and send involuntary signals to the muscles.

Gradual increase of exercise may increase the endurance of nerves, but there is no evidence to suggest stretching before exercise will reduce chance of cramping. Links between dehydration or electrolyte imbalance and cramping have not been proven in human research.

Over 60 year olds

Night cramps affect roughly a third of the older population. These symptoms most commonly affect the calf and may benefit from stretching during an episode. One reason over 60s are affected may be because of their likely use of multiple medications. There is a particularly strong link with statins and diuretics.

Manual therapy and exercise have been proven to be effective among this group.

Pregnant women

We see more leg cramps among pregnant women, but it is not entirely clear why. Cramping affect roughly half of pregnancies, and occur more frequently overnight. The third trimester is the time when this is most prevalent. As hormonal changes affect physiology from the first trimester, cramping can be more prevalent from the start.

As with other cases, we are not entirely sure why pregnant women are more affected than the general population. There are theories about weight gain and changes in circulation, but they are not strongly supported.

People with Fibromyalgia

A relatively common symptom among people with fibromyalgia is cramping. The cause is thought to be neurological as it is among other groups. However it is likely associated with the neurological element of fibromyalgia.

There are also links between a high numbers of cramps and people with:

  • Renal disease
  • Liver cirrhosis
  • Diabetes

Treatment for cramps

Evidence has shown that manual therapy can be effective for managing cramps. This is particularly effective for night cramps in over 60 year olds. Considering current theories, increasing exercise may also help to prevent this condition. Despite this, before exercise has not been proven effective for prevention. Some patients find that stretching during an episode does help to relieve pain, however.

See what we can do for you. Book an appointment online here.

Arthritic Pain

Osteoarthritis and associated arthritic pain can affect any joint in the body where there is a cartilage covered bone. Commonly it affects joints of the hands or feet, spine, shoulders, hips, and knees.

Arthritic Pain

Why is arthritis painful?

Some of the pain actually comes from the body’s attempts to protect itself from discomfort. When arthritis affects part of a joint surface, it becomes uncomfortable to move through that range. Rather than purely stopping a movement at that painful range, the body tries to find a way around it. This might mean changes to posture or the way you walk, which in turn asks more of other muscles and joints.

So alongside the arthritic pain itself, you feel the strain of muscles and otherwise healthy joints having to behave differently. If the muscles that act on the joint itself get tight to try and protect the joint, they can actually cause it to become more stiff. In later stage arthritis, the space within the joint reduces. Muscles around it holding it even tighter doesn’t help the cartilage to recover.

In more advanced arthritis, pieces of cartilage can break off within the joint and “catch” on movement. The catching is usually quite unpredictable as the cartilage floats loose within the joint, so it’s hard to anticipate and prevent the pain. This in turn can lead to more compensation as the body tries to prevent any painful movement.

What can we do for arthritic pain?

To ease the symptoms of arthritis, you need to manage both the effects of the changes within the joints, and the body’s reaction to them.

Cartilage is happiest when it’s being compressed and decompressed fully. This allows waste products to be squeezed out to make room for nutrients to enter it. However, when a joint has a painful range, the body will avoid moving through that full range and pumping the cartilage as it should. It can take some work to encourage the body to move normally again.

During treatments with your osteopath, we can use gentle movements to convince the body that it is safe to move how it used to. This starts the process of compressing and decompressing the cartilage again, meaning the environment around the cartilage is already more healthy after the first treatment. Over time, and with exercise, the cartilage is given the best chance it can have to heal, or at least slow the progress of arthritis.

Your osteopath will also work to ease off the over-protective muscles that might be holding the joint stiff. If other areas are adapting as mentioned above, this can also be addressed.

Arthritis is not something you just have to live with until you can get a joint replacement! Book now to start getting your movement back.

Preventing Migraines

Migraines are not just headaches: they can come with a number of additional symptoms.

Symptoms of migraines

Symptoms of Migraine

Not every migraine will include every symptom, and not every symptom will be present at the same time. Most symptoms last under an hour but the headache can last longer.

  • A throbbing headache on one side of the head or focused over an eye
  • Nausea or vomiting
  • Altered sensation in the arm or jaw area
  • Visual aura preceding the headache

Migraines are still not fully understood. The two main theories accepted today are that they are caused by nerves or blood vessels. However, there seem to be a number of associated factors that vary from person to person.

Factors that may lead to Migraines

Keeping a food diary can be a great way of spotting triggers. A huge array of ingredients have been associated with migraines, so pinning down any that specifically affect you is important. Another common factor is sleep: both too much and not enough.

Stress is often cited as a factor in migraines, with some people finding their symptoms come on as soon as they are put in a stressful situation. The link between stress and migraines could lie in tension. If your body responds to stress by tensing your shoulders and neck, this might have a direct effect on the nerves and vessels considered responsible for migraine. Osteopaths are qualified to help with the management of tension in muscles.


You may find that if you feel the first symptoms of a migraine coming on, you can halt its progression yourself. Often this means lying in a dark room or taking some medication, but this doesn’t work for everyone.

Some patients find that manual therapy is more effective in reducing their migraines than medication. Alongside the aforementioned management of tense muscles, osteopaths can work on joints to improve the function of the musculoskeletal system as a whole. This may help to reduce frequency or intensity of migraines.

If you suffer from migraines, book an appointment so we can find what works for you.