Avin Patel

Carpal Tunnel Syndrome

The carpal tunnel is a narrow space in the wrist. Nerves and tendons pass through here on their way to or from the hand.

The carpal tunnel

The median nerve runs through the tunnel, and it can be irritated in this small space. This nerve supplies some of the palm with sensation and movement.

When the nerve is irritated, it can cause pain, weakness, numbness, and pins and needles in the area it supplies. These are symptoms of Carpal Tunnel Syndrome (CTS). These symptoms are often worse at night, potentially due to compression of the wrist while sleeping. Bending the wrist is an aggravating factor in itself.

How Carpal Tunnel Syndrome Occurs

The nerve can be irritated in two ways: from pressure from within the tunnel, or from outside.

Internal Pressure

Overuse of the muscles whose tendons run through the tunnel can cause CTS. This is generally agreed to be the most common cause of CTS. Previously known as “repetitive strain injury” or RSI, this can be associated with excessive computer work. The effect on the carpal tunnel is more apparent with poor ergonomics- resting the wrists on a hard desk while typing adds more pressure to the nerve.

Anything that reduces space within the tunnel can predispose CTS. One common factor is fluid retention, as may occur with:

  • pregnancy
  • kidney disease
  • heart failure
  • some medications

As cells become more full of fluid, they take up more space and can lead to compression.

External Pressure

Positional problems can cause unnecessary pressure on the nerve from outside the tunnel. One reason that symptoms may be worse overnight is that we commonly sleep with a flexed wrist. This causes compression through the tunnel, and can encourage symptoms to develop overnight.

As discussed previously, direct pressure to the wrist at work will also apply external pressure.

Persistent Symptoms of Carpal Tunnel Syndrome

Occasionally we see patients who still have symptoms after CT release surgery. This is a procedure to make space in the tunnel by cutting the band of tissue near the surface. Persistent symptoms tell us that either there is something in the wrist that continues to cause irritation, or it’s not the wrist at all.

The median nerve can also be irritated further up the arm, causing similar symptoms but having nothing to do with the wrist. One of the muscles that turns the hand over is another point at which the nerve can be compressed. Alternatively, other nerves could be irritated as far up as the neck, causing discomfort, weakness, or numbness into the hand. However, this latter alternative is unlikely to mimic CTS so closely.

Persistent symptoms without surgery do not necessarily mean that surgery is the answer. As overuse of the wrist muscles is considered the most likely cause on average, it makes sense that symptoms may remain as long as the wrist is overused. Your osteopath may be able to help here.

Treatment

Osteopathy is built on the principle that the body can heal itself. As mentioned above, this may be as simple as changing a movement to remove an aggravating factor. Whether this means strengthening one muscle group to take the load off another, or advising the use of a splint overnight,

In the case of wearing a splint, it may be possible to work on other factors at play in order to avoid reliance. Advice such as using ice, or self massage to reduce the impact of overstrained muscles can help here. Techniques from the treatment room that may be adapted for exercise at home could include gentle “flushing” techniques. These aim to reduce any inflammation or fluid build up in the wrist.

For help managing symptoms of carpal tunnel syndrome, book now.

Cranial Osteopathy

You may have heard news from celebrities getting cranial osteopathy for their newborns. Joe Wicks recently made headlines, as has Pippa Middleton. But what is cranial osteopathy, and why would you want it?

Cranial osteopathy for newborns

What is Cranial Osteopathy?

Cranial osteopathy is actually a treatment for both babies and adults. For babies, this gentle approach can give quick results for problems that may have developed at birth or in the first few weeks of life. One common problem is muscular asymmetry in the neck, which may be diagnosed as torticollis if it becomes more significant.

In October 2019, Pippa Middleton wrote an article in the Waitrose Weekender about her baby’s cranial osteopathy,  reporting that “the osteopath noticed one side of his neck was tighter than the other, which explained why he favoured one side sleeping.” 

As with other forms of osteopathy, the osteopath will take a case history, and assess the feel and movement of tissues in the affected area. When they have an understanding of the problem, they can deduce whether cranial treatment is appropriate.

What Does Cranial Treatment Entail?

The osteopath holds the patient’s head, typically while they are lying on their back. They feel for small movements or imbalances, and use gentle movements to encourage the body to correct itself. This may look like nothing is happening at all- it’s not a spectator sport!

Due to the gentle nature of treatment, any adverse effects are likely to be transient.

Treatment for Newborns

Babies are very responsive to treatment, which means cranial can be particularly effective for them. However, it also means they might react to imbalances in day to day movements. Difficult birth, particularly where the baby was in an awkward position or needed intervention, might cause strains or discomfort through the body.

Very young babies can have a lot of abdominal discomfort too. When they are very young, the bowel does not push waste through (peristalsis) as well as it does in adults. This means they might have to actively push more, or they might experience tummy aches. The only symptom may be crying or general fussiness, which can be hard to pin down to one specific cause. An osteopath may be able to help through cranial treatment, or more direct treatment to the abdomen.

While babies’ skulls are still underdeveloped, the bones are not fused. This means that excessive pressure on one side can change the shape of the head, for example if they like to turn their head one way over the other. As mentioned above, cranial osteopathy can help with the root cause of this if it is due to tightness in one side of the neck. Direct cranial treatment to the skull may also help.

Treatment for Adults

Cranial osteopathy complements generic osteopathy well. For adults, cranial may help with tinnitus or problems with the jaw.

Many people find this kind of treatment particularly relaxing, and may opt in to it for stress related conditions, including some problems with the diaphragm, bowel, or shoulders. Stress related headaches may also benefit.

Book an appointment here.

Kyphosis and Lordosis

Unlike having a scoliosis, it is not a problem, nor a diagnosis to “have a lordosis”. Everyone more than a few days old will have them, and you will have had your kyphosis since before birth.

Kyphosis and Lordosis

Kyphosis

A Kyphosis is an area of the spine that sticks out. The main one is the upper back, or thoracic spine. There is a secondary one in the sacrum and coccyx (tailbone).

Some conditions lead to a more prominent kyphosis, such as osteoporosis and Scheuermann’s disease (formally known simply as “kyphosis”). In these cases, the shape of the bones in the upper back is changed. Osteoporotic vertebral crush fractures typically cause the vertebrae to become wedge shaped. Scheuermann’s leads to wedge shaped vertebrae too, although this is due to the speed at which the front and back of the vertebral body is growing. If increased thoracic kyphosis is accompanied by discomfort or reduced movement, your osteopath may be able to help.

Lordosis

A lordosis is where the spine dips in. There is a lordosis in the neck, and another in the lower back. These are known as the cervical lordosis and lumbar lordosis respectively.

One period in which the lumbar lordosis may become exaggerated is in pregnancy. As the bump grows, the body may arch the back in reaction. This can cause intermittent pain by compressing the structures at the back of the spine. Although this will only be a temporary problem, we may be able to help in the meantime.

Kyphosis, Lordosis, Posture, and Pain

You may have seen images online labelling different postures alongside the “good” posture. In reality, we are all built as differently on the inside as we are on the outside. Therefore, one person’s “perfect posture” would be different to another’s.

The real problem is being too still for too long. If you stood still in the most perfect position for a couple of hours, you would have some sort of discomfort. We are designed to move, and moving through “bad” postures will always be necessary sometimes.

As a general rule, if the way you stand and move does not cause any problems, it does not need changing.

Osteoarthritis and Spinal Curves

The thoracic kyphosis and cervical lordosis become more apparent in people with advanced hip osteoarthritis. The body compensates for the lost movement in the hip by bending forwards, then brings the head back up with more extension in the neck.

The ideal solution is to catch it before reaching this stage, but there may be something that can be done further down the line. If your hip arthritis has led to a joint replacement and you are left with this posture, we can help to train your body back to where it should be.

If you’re worried about your posture, or just want a check up, you can make an appointment online now.

Pregnancy and Osteopathy

Pregnancy may be the time in which the body goes through the most changes in the shortest period. Like any other significant physical change, this can lead to discomfort. Although we expect some discomfort in pregnancy and post-partum, not all of it is unavoidable.

Lower back effects of pregnancy

Back and Pelvic Girdle Pain

One of the biggest causes of pain in pregnancy is the lower back and pelvis. From very early on in the first trimester, the body produces a hormone to relax ligaments. Its aim is to loosen the pelvis in preparation for birth, but its affects are more wide reaching.

Pelvic girdle pain (PGP) is pain that can affect both the front of the pelvis and the two sacroiliac joints at the back. It can be worse going from sitting to standing, or turning in bed at night. Some people find it feels better with exercise, but that it will feel a lot worse the next day. PGP is a result of the changes your body is going through, so it might be quite unpredictable in nature. Your osteopath can work with you to identify the factors that make your PGP better or worse. We can also give you exercises to complement the work we do in clinic.

If you have PGP in the run up to birth, you may need to alter your birth plan to accommodate it. It is advised to avoid wide-leg positions in this case. For maximum freedom in the delivery room, seek treatment sooner rather than later.

Sciatica and Piriformis Syndrome

Postural changes in response to a changing centre of gravity can mean more demand on the muscles of the back, buttocks, and hamstrings. These muscles just so happen to be in the same area as the sciatic nerve.

Piriformis syndrome in pregnancy

Sometimes a mix of strengthening and stretching is enough to ease off symptoms. In Piriformis Syndrome, the sciatic nerve is irritated by a tight muscle deep in the buttock. If pregnancy posture is to blame, we can work to alter the way you stand, or advise lifestyle changes to minimise chance for irritation.

Typically, the longer a nerve spends in an irritated state, the longer it takes to calm back down. Don’t wait for your symptoms to get unbearable before you seek help.

Carpal Tunnel Syndrome in Pregnancy

The same hormone that relaxes ligaments also has an effect on the circulatory system and kidneys. Water retention and cramps may be related to this, as more fluid is present in body tissues. This generalised low-level swelling is responsible for an increase in risk for carpal tunnel syndrome during pregnancy.

Carpal tunnel syndrome in pregnancy

The carpal tunnel is the space beneath a ligamentous tissue in the wrist. Nerves pass through this narrow tunnel, and can be compressed when there’s excess pressure in the area. This can be due to aforementioned water retention, or repetitive strain to the muscles that pass through.

Your hormonal causes of this water retention will resolve after birth, but your osteopath can help in the meantime. Treatment and exercises to clear the fluid from the wrist can give some relief. We can also look elsewhere in the arm to see if anything else is contributing to the pressure. If appropriate, we can also advise on the use of a wrist support or cool compress.

Osteopathic Treatment in Pregnancy

Osteopathy is a gentle, conservative therapy. Some patients prefer to avoid any kind of manual therapy during the first trimester, which would still give plenty of time to address any aches and pains before they progress.

If you’re suffering from muscular or joint pain during pregnancy, book now to get on top of them before birth.