Avin Patel

Chronic Pain

Chronic Pain is defined as pain lasting over three months. This may be due to a constant stimulus, such as an arthritic joint, or it might be Primary Chronic Pain

Chronic pain is multifactorial

Primary Chronic Pain (PCP) is a pain condition that cannot be attributed to another cause. This encompasses conditions such as:

Risk Factors

Some of these conditions affect certain demographics, some of which cannot be changed. Migraine and fibromyalgia are more commonly diagnosed in women, for example. However, chronic pain is also associated with a number of modifiable factors.

We know that smokers are more likely to suffer from chronic pain conditions. Similarly, poor diet is considered a risk factor for chronic pain. Poor or insufficient sleep also predisposes a person to develop it. Mental health conditions often come hand in hand with pain too. To summarise, the more you can improve any facet of your health, the less likely you are to develop a pain condition.

The Psychology of Pain

A prominent pain scientist, Lorimer Moseley, explains how the brain plays a role in how we perceive pain. If you are walking through tall grass and feel a small scratch, you probably won’t feel much pain. But what if that scratch later turns out to have been a snake bite, and you end up hospitalised and in agony? Next time you go walking in tall grass, a small scratch from a twig could genuinely feel like a snake bite. The brain wants to protect you, and it can learn to amplify the danger signal if it deems it necessary.

This is why understanding your condition is so important for a good prognosis. To take the snake analogy further- you’re much less likely to get that massive pain response if you see the twig brush your leg. The brain now has two pieces of information to use when deciding what would be a proportional reaction.

Lorimer Moseley has done another video specifically for chronic pain. You can watch it here.

Chronic Lower Back Pain

Back pain can become a PCP condition if the original cause resolves, but the pain does not.

Secondary Chronic Pain (SCP) contrasts to PCP in that the pain is attributed to a structural condition. In that sense, long term Lower Back Pain caused by osteoarthritis, osteoporotic fracture, or chronic disc bulge could be SCP. As this pain is due to a constant stimulus, it may not follow as many of the risk factors listed above as PCP. But it can still be debilitating, and treatment needs to be multifaceted. We want to treat the cause, but also the compensations, and the associated sensitivity that may have developed.

Frustratingly, diagnosis for chronic lower back pain is not as easy as going and getting a scan. Not all structural things show up with imaging, and most of us have asymptomatic things that may look like a problem on a scan. These false positives are the reason the NHS does not recommend routine scanning for lower back pain. Your osteopath can be your first port of call for most cases of lower back pain.

If your pain has crossed the three month threshold, book an appointment now to see how we can help.

Labrum Tears

“Labrum” is latin for “lip” and refers to the ring of cartilage that supports some ball and socket joints. Both the hip and shoulder joints have labra.

Labrum Injuries

Ball and socket joints are particularly mobile, and the labrum helps to keep movement within a healthy range. But it is possible for the labrum itself to be injured, often by a forceful injury.

Cartilage is slow to heal, so symptoms can persist for a while if not addressed. Your osteopath will aim to improve local joint health to aid healing. They can also advise you on how to best look after the joint as it heals.

Shoulder Labrum Injuries

The shoulder is a very mobile joint. This is due to the small and shallow socket. Unfortunately, this means that it is not the most stable joint. We rely on the soft tissues (ligaments, muscles, and cartilage) around the joint to protect the it.

SLAP Lesions

SLAP stands for Superior Labrum Anterior + Posterior. This kind of injury is particularly prevalent among throwing athletes, but can also be caused by a fall or other trauma. It occurs near the point where the biceps tendon attaches to the labrum- an area under a lot of stress during throwing movements.

This problem may present with pain, stiffness, and clicking or locking of the shoulder on certain movements. It may be particularly difficult to use the arm in overhead movements, or performing movements like putting on a coat sleeve.

Hip Labrum Problems

Hip labrum injuries may be caused by road traffic accidents, falls, or shearing forces as with twisting. Although the hip socket is deeper and therefore more stable than the shoulder, the cartilage can still be injured. Symptoms are often quite generic to a number of hip problems, and may include:

  • Pain in the groin or front of thigh
  • Clicking of locking of the joint
  • Pain on activity

FAI: Femoral Acetabular Impingement

FAI is slightly different. Rather than being a form of labral tear, its presence can predispose the development of a tear. In this condition, part of the ball and socket is misshapen. This can affect the “ball” after childhood issues: Perthes Disease, repetitive movements, or some fractures can predispose this. The socket can cause the same problem if it extends further than it should.

The problem with FAI is the ball makes excessive contact with the socket, causing pain and stiffness. These symptoms are particularly evident after periods of prolonged or repeated hip flexion, such as sitting or performing squatting exercises. This unusual force can play a role in the development of FAI later in life. FAI is also associated with the development of osteoarthritis in the hip, so it’s well worth doing something about it.

Management

Cartilage is slow to heal, but benefits from full, gentle movement. This can be difficult to achieve on your own, as the necessary movement may be painful. Your osteopath can do this movement for you, and give you exercises to achieve the movement yourself. When a joint is painful, the muscles around it often tighten it up to protect it. Unfortunately, this prevents the required movement from happening organically. We can help relax these muscles too, to give your body the best conditions in which to heal itself.

If your hip or shoulder injury sounds like this, get in touch with us today.

Bunions

Bunions are a common foot condition that can cause episodes of pain. When these episodes occur, there are things you can do to manage the symptoms.

Bunion

What is a Bunion?

A bunion is a soft tissue swelling on the outside of the foot at the base of the little toe. This joint is the 1st metatarsophalangeal joint (1st MPJ). More specifically, the exact area affected is the metatarsal head. This part of the foot does stick out slightly in everyone, but is more prominent with a bunion.

Over time, the swelling will progress to misalignment of the joint, with the toe pointing into the rest of the foot. The swelling looks larger, as the joint begins to push outwards. Symptoms can include redness over the area, a callus, and tenderness. Symptoms may come and go over months or years.

Inappropriate footwear is a significant factor in the development of bunions. Pressure on the joint from tight fitting or high heeled shoes can cause enough irritation to start the process. It is also possible for local trauma to cause the initial irritation. Another name for the condition is “tailor’s bunion” in reference to the pressure of sitting cross-legged as a tailor might.

Some people are more predisposed to developing the condition due to their anatomy. If the 5th MPJ naturally sticks out (and the toe points in), they may be more likely to irritate the area. There is also a strong genetic link.

Rheumatoid Arthritis and Bunions

The small joints of the feet are among those most commonly affected by Rheumatoid Arthritis. For people with RA, bunions can be harder to manage. Joints affected by rheumatoid conditions like these need frequent, gentle movement. Prolonged rest or excessive exercise will aggravate symptoms.

Management

Typical advice for an aggravated bunion is to rest and ice it. Some people also find that a bunion cushion or pad can help take some pressure off. Rest and ice are measures used temporarily to manage acute symptoms. They aim to reduce redness and swelling, but it is important not to over-ice. Rest is also only beneficial in the short term- healthy movement will do more for the joint than keeping it still over a longer period.

Sometimes a bunion is caused by supination (or under-pronation) of the foot. That means that your foot has rolled out, and often comes with higher arches. Walking like this puts direct pressure on the area a bunion may form. Your osteopath can look at the way you walk to determine what has caused this supination, and address it with treatment if appropriate.

Your osteopath can give you advice beyond the standard recommendations:

  • Avoid excessively tight footwear
  • Avoid high heeled shoes that apply extra pressure to the ball of the foot

Exercises may be useful to keep the small joints of the foot mobile.

Book an appointment here to start managing your bunion.

Tennis Leg

Racket sports encourage movements that can lead to Tennis Leg. This is a colloquial term for an upper calf injury. The muscles at the top of the calf are involved in ankle plantarflexion (pointing the toes). Sports like tennis, squash, and badminton sometimes require powerful use of this muscle, for example when lunging forward quickly with a straight knee.

Tennis leg: muscles and actions involved

What is Tennis Leg?

Most often, this is a tear of one of the muscles of the calf: the gastrocnemius. Less often it is a plantaris tendon rupture. It comes on suddenly, and can be directly caused by the movement mentioned above. Sometimes it will feel like the calf was kicked, or something popped. After onset, pain is brought on by stretching or engaging the calf. Therefore, you may find yourself walking on tip-toes on the affected side.

This injury can present with a tracking bruise. Alongside potential local bruising, there may be a significant bruise in the foot or ankle- immediately below the injury. This is the same process that happens with some ankle sprains: a bruise is made of blood, and blood can pool under gravity.

Osteopathic Treatment

As Tennis Leg is a minor sports injury, your osteopath is qualified to help you.

The first two weeks after onset make up the acute period for soft tissue injuries like this. There are a lot of things you can do at home to minimise discomfort and facilitate healing at this time, and your osteopath can give you tailored advice. However, the basics are:

  • Apply a cool compress
  • Elevate the leg to prevent excess swelling
  • Use a support with gentle compression
  • Reduce weight bearing temporarily: crutches may be beneficial

After the initial inflammation subsides, the body begins to repair. At this point, it is important to be using the leg to some extent in order to help with remodelling. Your osteopath can help with work to the soft tissues as well as more advice.

Recurrent Injury

As part of your treatment plan, your osteopath will want to work on prevention of future episodes. Alongside stretching and warming up before exercise, we will look for other factors that may have played a role. Restrictions in the hip or ankle may cause overloading of the calf, so treating these issues could help with prevention in the future.

About 1/5 people report having felt some general calf tightness in the days leading up to their injury. If this applies to you, it will be especially important to work on calf tension as part of your rehabilitation.

Regular stretching is easiest to do when it becomes part of a routine, but establishing that routine can be the hard part for some people. If this applies to you, you might find that having a visual reminder helps- such as a foam roller. Seeing the tool you need to use can be enough to get you into that routine, so mention this to your osteopath if it would help you.

Book an appointment online to manage your sports injuries