Avin Patel

Osteoporosis and Osteopenia

Often mistaken for osteoarthritis, osteoporosis is a condition of reduced bone density. Its less severe sibling is osteopenia. Both are diagnosed by special processing of an X-ray image.

What is Osteoporosis?

Measuring bone density gives us a good idea about the strength of bones, and indicates whether there is an increased risk of fracture. Bone density can be measured using an X-ray, which allows a figure to be calculated based on appearance. This is then compared to an average score to determine whether density is adequate or low. Before developing into osteoporosis, bone will become osteopenic. This means that density is reduced, but does not yet cross the threshold.

Osteoporosis and osteopenia vs normal bone density

An X-ray is performed on the lower back (lumbar spine) and hip. This data is used to calculate the bone density.

Risk Factors

Post-menopausal women are in the category most likely to lose bone density. Due to the hormonal changes that lie behind this risk factor, women who have had their ovaries removed are also at higher risk. If a woman goes through the menopause early, whether spontaneously or due to surgery, she may be offered hormone replacement therapy (HRT). This negates the hormonal shift and reduces the risk of a drop in bone density.

Some medications also affect bone density. Longer courses of steroids and anti-oestrogen medications can play a role here. Being underweight or having a history of an undereating disorder are also linked.

Relevance to Osteopathy

Osteoporosis is a systemic condition, and not something that we can directly help with. However, we still need to know if you are affected by it, as its presence means there are some areas that need a more gentle treatment. Sometimes there are no signs of osteoporosis until a bone is fractured, so preventative management and testing are important.

As osteoporotic bones are also more likely to fracture, we need to know if we should be considering this kind of injury. Fractures are out of our remit, and appropriate attention is somewhat urgent.

Sometimes people come to clinic for help in correcting their posture. Although sometimes the cause of a hunched posture is something we can help with, like hip arthritis, it can also be an effect of osteoporosis. When bone density is low, the spine can be affected. At this point, a minor fall or even a cough or sneeze can sometimes be enough to cause a crush fracture. This is where the large parts of the vertebrae (which weight bear) collapse in on themselves. They tend to settle into a wedge shape, which changes the shape of the spine. As we cannot change the shape of the bones, we cannot resolve this. We may, however, be able to provide some relief if there are compensatory muscle and joint pains associated with it.

Management and Prevention of Osteoporosis

The most effective treatment for osteoporosis or osteopenia is to gradually and gently increase weight bearing exercise.

Your doctor may also recommend that you take medication to strengthen the bones. Strong bones need minerals such as calcium, so there may also be dietary changes you can make to help yourself. Not only is it necessary to consume the minerals required, but vitamin D will help you absorb them.

If you need help to get back into exercise for your bones, make an appointment in Leicestershire here.

Bursitis

Bursitis means “inflamed bursa”. Bursae are little fatty sacs called found all over the body. Each bursa sits between tissues, often a tendon and a bone, that would otherwise rub together. Their role is to prevent injury by friction, but sometimes they become irritated themselves.

How it Happens

Bursae tend to become inflamed from excess pressure or friction, which can be internal or external.

Internal friction usually comes from a tight muscle repeatedly rubbing against the bursa. Pain in this case could be in both the muscle and bursa. External pressure is often behavioural, for example sitting in such a way that a bursa is under continual pressure.

More Common Examples

There are too many bursae to count, but some come up more than others. 

Bursitis: hip and knee bursae

Trochanteric Bursitis

At the top of the thigh bone there is a bony lump called the greater trochanter. Some people call this their hip, although it is below the hip joint. The IT band and the muscle that it blends with (TFL) run over this prominence. The ITB is usually relatively tight, as it plays a role in stabilising the knee. But if it becomes too tight and puts too much pressure on the bursa, you can develop trochanteric bursitis.

Due to the relationship with the knee, treatment might involve more work to the knee or even ankle than to the painful area itself.

Patella Bursitis 

There are two bursae around the knee cap that are quite prone to irritation. The infrapatellar bursa sits just below the knee cap, and the prepatella bursa is in front of it. When these are inflamed, the quadriceps are often part of the problem. The knee cap actually sits within the quadriceps tendon, so tightness in the quads can make the kneecap move inefficiently.

When the cause of this is tightness through the quads, additional problems may arise. The additional pressure on the knee cap can cause friction within the joint too. If this persists, the cartilage on the back of the knee cap may become irritated. Given long enough, it may also develop arthritis.

Olecranon Bursitis

The olecranon is the name for the point of your elbow. Bursitis here is less associated with a tight muscle, and more commonly caused by external pressure. The other name for this bursitis is “student’s elbow”, as leaning the elbow on a desk is associated with developing it. As the bursa is so close to the skin, it can look quite dramatic when inflamed. A large lump may develop, which is not painful in every case.

Osteopathy and Bursitis 

Osteopaths can help with your tight muscles. When assessing your bursitis, we will look for patterns in neighbouring areas. It may be the case that the long term solution to your pain is to address a muscle or joint elsewhere that isn’t working properly. 

Book an osteopathic appointment in Leicestershire here.

Snapping Hip Syndrome

Painless “snapping” in the hip, whether heard too or just felt, can be worrying. Most of the time it’s just a muscle flicking over, but it’s still worth checking it out.

Snapping hip: lateral and anterior types

Muscular Causes of Snapping Hip

The formal name for snapping hip is Coxa Saltans, which only applies when the cause is a muscle. There are three categories of this:

  1. lateral or external (most common)
  2. anterior or internal (relatively common)
  3. posterior (rare)

The category refers to the muscles involved. The common two involve a muscle of the glutes, or a deep abdominal muscle. The rare type involves a muscle from the hamstrings.

If this is caused by a tight muscle, your osteopath will work out whether this is an isolated symptom. Sometimes muscles become tight because of posture- your hip flexors will shorten if your hip is always flexed. Other times, there may be tightness in response to instability or hypermobility. If this is the case, we want to release the muscle but also strengthen it so that it can do the job more comfortably.

Snapping Hip as a Sign of Something Else

Although the syndrome is painless, it may still be an indicator of something else. In the lateral type, the ITB can be the tissue that flicks over. The ITB is something between a muscle and a joint, and it runs from the outside of the hip to the knee. Runners often find that it is tight and may be sore, but it might be tight for a reason. The role of the ITB is to stabilise the knee, so treating the tightness without looking at the knee is not the best idea.

Sometimes, especially in the second type, the snapping may be caused by muscle flicking over a bursa. Bursae are little fatty cushions that prevent friction between muscle and bone. They are found all over the body. If irritated, they can become very sore and develop bursitis. If a click hip is a warning sign of this, it would be ideal to prevent its development.

Your osteopath will look at everything going on, and determine the root cause of your snapping hip.

Snapping Within the Joint

When the cause of a hip clicking is not muscular, it might be due to something within the joint. This is more likely to be the case if the clicking is painful, or if there is ever locking of the joint.

Labral Tear

There is a lip of cartilage around the ball and socket joint of the hip. This can become injured, and tear. When the labrum is damaged, the joint may become painful and less stable. You can read more about labral tears here.

Loose Body of Cartilage

There is also cartilage on the joint surfaces of the ball and socket. Through injury or arthritis, a piece of the cartilage can break off and float loose within the joint. Symptoms of this can be quite unpredictable, as they are only caused when the loose piece is in a specific condition. When aggravated, there may be stiffness or locking alongside the snapping, and pain within the hip. Hip pain often refers to the groin, so let your osteopath know if you also have pain here.

You can book an appointment for your snapping hip here.

Shin Splints

Avin has a special interest in sports injuries, of which shin splints are a common example.

Signs and symptoms of shin splints

Symptoms of Shin Splints

Also known as Medial Tibial Stress Syndrome, symptoms affect the inner side of the shin. Pain may come on at the start and end of exercise, disappearing in between. As it gets worse, pain may persist through the day. There will be an area on the shin that is tender to press into, and there may also be some slight swelling over the same area.

Running is commonly associated with the development of shin splints, but other sports can cause them too. The exact science of what happens anatomically is unclear, but there is a link with repetitive high force from the muscle onto the bone. Powerful movements such as jumping are also associated.

It is important to note that this is not the same as a stress fracture. However, a stress fracture may follow if the condition and its cause are not managed. Although the two have similar symptoms, initially a stress fracture will feel better after rest, whereas shin splints will feel worse.

The muscles around the shin bone (tibia) are involved in shin splints. Their role is to move the ankle, which explains why running and jumping are the common causes. Typically, there is an inflammatory reaction where these muscles meet the bone. This may involve inflammation of the outer layer of bone itself, or it might be the connection between the muscle and bone.

Prevention of Shin Splints and First Aid

We know that shin splints tend to come on when either:

  • an action is performed incorrectly
  • too much is done in too short a period

So when thinking about prevention, we need to be thinking about form and graded exposure.

There is also a connection with running on hard surfaces, or with poor shock absorption from inadequate footwear. Proper running shoes that are replaced after about 300 miles may help. If possible, running on softer ground might also help to prevent the development of shin splints.

As the condition is involves inflammation, a cool compress is ideal for first aid. You never aim to numb the area, just to cool it down. This takes the edge off the swelling and pain without hindering the healing process. The NHS has advice for painkiller use here.

Your Osteopath’s Role

The appropriate management will depend on how soon you come to clinic after your injury. A brief period of rest is recommended in the first few weeks. After this period, we can support you in graded return to your chosen exercise. This might mean running for shorter distances, or running fewer days per week. We may also ask you to choose a flatter, more even surface in this phase.

As always, we will also look elsewhere for other relevant factors. For example, if your ankle movement was restricted, the muscles may have to work harder to perform the action you’re trying to do.

Your osteopath may be able to help you with your training programme, or put you in touch with someone who can. If the problem has been that you have overloaded the area, we can help with strengthening and rehabilitation.

You can book an appointment here to start managing shin pain.